Moderate alcohol intake may increase risk of HF progression

A moderate to high intake of alcohol appears to increase the risk of heart failure (HF) progression in individuals with pre-HF, according to a study presented at Heart Failure 2022.

“Our study suggests that drinking more than 70 g of alcohol per week is associated with worsening pre-HF or progression to symptomatic HF in Europeans,” said study author Dr Bethany Wong from the St. Vincent’s University Hospital in Dublin, Ireland.

The results were based on a secondary analysis of the STOP-HF* trial which involved 744 individuals aged >40 years (mean age 66.5 years, 53.1 percent female) with stage A/B HF (with risk factors for HF/with pre-HF) who had echocardiography and information on alcohol intake at baseline and at ≥18-month follow-up. Alcohol intake was categorized as no alcohol intake, low alcohol intake (1 unit/day or 70g/week), and moderate-high alcohol intake (>1 unit/day or >70g/week). Former drinkers and individuals with symptomatic (stage C) HF were excluded.

About 35 percent of participants (n=260) had stage B HF at baseline. Hypertension and diabetes were reported in 74.7 and 19.5 percent of participants, respectively. Twenty-seven, 47.8, and 25.1 percent reported no, low, and moderate-high alcohol intake, respectively. Alcohol intake was comparable between participants with stage A and B HF.

The participants were followed up for a median 5.44 years during which time 11.3 percent (n=84) had progression of stage B/C HF (ie, left ventricular dysfunction [ejection fraction <50 percent] and a decline of ≥5 percent and/or lateral E/e’ >13 increase of ≥2 units).

Participants with moderate-high alcohol intake were younger, and more likely to be male and have a higher body mass index than those with low alcohol intake.  

Among participants with stage B HF at baseline, those with moderate-high alcohol intake had a 4.5-fold (95 percent confidence interval, 1.7–15.9; p=0.004) increased risk of progression of stage B/C HF than those with no alcohol intake. [Heart Failure 2022, session: Heart failure is a complex syndrome: look at comorbidities]

This increased risk of progression was evident in participants with moderate (70–140 g/week) and high (>140 g/week) intake of alcohol.

Among individuals at risk for HF, moderate-high alcohol intake was not tied to the risk of progression to pre-HF or to development of symptomatic HF. Low alcohol intake did not protect against HF progression in any of the patient groups.

These results are similar to those of a Korean study that found a negative effect of increased alcohol consumption on left ventricular structure and function and no benefit with light (1–15 g/day) alcohol consumption. [Eur Heart J Cardiovasc Imaging 2018;19:271-278]

“This study adds to the body of evidence that a more cautious approach to alcohol consumption is needed,” said Wong.

“We did not observe any benefits of low alcohol usage. Our results indicate that countries should advocate lower limits of safe alcohol intake in pre-HF patients,” she continued. This is due to some countries currently advising limits that exceed the safety levels identified in this study.

“More research is needed in Caucasian populations to align results and reduce the mixed messages that clinicians, patients, and the public are currently getting,” she said.

“To minimize the risk of alcohol causing harm to the heart, if you don’t drink, don’t start. If you do drink, limit your weekly consumption to less than one bottle of wine or less than three-and-a-half 500 mL cans of 4.5% beer,” Wong added.