Labor Day marks the traditional end to summer. Families and friends will celebrate the holiday by getting together, barbequing and having a few cocktails. How many of those holiday revelers will end up in the hospital the following week with atrial fibrillation (Afib) and Holiday Heart Syndrome?
Afib is a fast, irregular heartbeat from the upper chambers of the heart (the atria). If left untreated it is associated with stroke and heart failure. Holiday Heart Syndrome occurs in a patient who has recently had alcohol. It typically will occur two to four days after someone has had more alcohol than they usually are accustomed to. It is often seen after binge drinking, such as occurs during a holiday, thus the name. The Afib episodes usually start during the night. Most of the time the Afib resolves on its own, but Holiday Heart Syndrome is serious. Patients may need cardioversion (having their heart shocked back into a normal rhythm) or may need long-term treatment with heart medications and blood thinners. In addition, 20-30% of patients will have recurrent Afib events within a year of the initial presentation.
How much alcohol is required to induce Holiday Heart Syndrome? The exact amount is not known, but some recent studies have shed some light on the question. One study concluded that drinking alcohol increased the risk for Afib within a few hours and the more alcohol, the higher the risk. After only a single drink of alcohol, the risk of Afib increased two times in the next four hours. After two drinks, the risk increased to three times and there was a linear increase in risk from there (more alcohol, more risk). The conclusion of this study was that no amount of alcohol is safe for patients with Afib. Another trial from England showed that four drinks per week or less did not increase the risk for Afib. Higher amounts did increase the risk (resulting in a J shaped curve). They also showed that the type of alcohol mattered. Wine (both red and white) was not associated with increased risk for Afib, while beer and cider, in any amount, increased the risk.
But isn’t alcohol supposed to be cardioprotective? It is true that light drinkers live longer than those who do not drink and those who drink heavier amounts of alcohol (also a J shaped curve). Light drinking (approximately one alcoholic beverage per day) reduces total cholesterol, increases HDL (the “good” cholesterol) and may be associated with a lower risk for heart attack. However, the data for the harmful effects of alcohol is stronger than the data for its beneficial effects.
Alcohol doesn’t only affect the heart. Alcohol use affects brain function. One study showed that any alcohol use decreased brain structure and function compared to those who do not drink. The conclusion of the study was that no amount of alcohol is safe for the brain. Similarly, when it comes to cancer, no amount of alcohol is safe. Alcohol has been linked to several cancers including cancers of the mouth, throat, esophagus, colon, rectum, and breast as well as leukemia and multiple myeloma. The more alcohol consumed, the higher risk for cancer. Even light drinking was associated with esophageal and breast cancer.
To summarize, the effects of alcohol on the heart are conflicting and confusing. Low amounts of alcohol intake can decrease mortality and help with the plumbing (less blockage in the heart arteries), but even those low levels can increase the risk for electrical problems (Afib). In addition, there is no safe amount of alcohol in cancer and for the brain. However, there is no safe level of driving. If you never get in a car, then you can never have a motor vehicle accident. No one recommends that people stop driving. Some level of risk is present in everything that we do. The idea is to balance the risk of everyday life versus hiding in a closet.
In order to stay safe this Labor Day Holiday and reduce the risk for Holiday Heart Syndrome, here are some recommendations. If you have a history of AFib, it is likely best to avoid alcohol, or, if you must drink, have only a single drink on rare occasions. If there is no history of AFib, limit alcohol use to one drink maximum per day and drink only a few days per week. Taking a day off from drinking helps the body to recover. Also, consider consuming wine rather than beer or cider. Stay safe and have a Happy Holiday.
