Can lifestyle changes affect atrial fibrillation? - Harvard Health

In particular, cutting back on alcohol may lessen the burden of this common heart rhythm disorder.

As many as six million people in the United States have atrial fibrillation, a rapid, irregular heartbeat that usually comes and goes without warning. Commonly known as afib, it can leave people lightheaded, breathless, and extremely tired. Even more worrisome is the fact that people with afib face four to five times the risk of stroke than those without the condition.

Medications and procedures can help ease afib symptoms and reduce the risk of stroke. "But people frequently ask me and my colleagues whether any lifestyle factors can make a difference in afib," says Dr. Paul Zei, director of the Comprehensive Atrial Fibrillation Program at Harvard-affiliated Brigham and Women's Hospital. The answer is yes — and a provocative new study has strengthened the evidence about the role of alcohol in people with afib (see "Does abstinence make the heartbeat stay steady longer?").

Does abstinence make the heartbeat stay steady longer? Australian researchers studied people with atrial fibrillation (afib) who were also regular drinkers. Here's a summary of their findings, which were published January 2 in the New England Journal of Medicine: Who: 140 adults with afib, mostly men, with an average age of about 63. All were moderate to heavy drinkers, consuming 10 or more drinks per week. How: Researchers randomly assigned half of the participants to abstain from alcohol and the other half to continue their usual drinking habits. To assess how long they spent in afib, researchers had participants send them 30-second electro-cardiograms (ECGs) twice a day and whenever they experienced afib symptoms. The ECGs, which record the heart's electrical activity, came from various sources, including pacemakers and special sensors that connect to a smartphone. What: During the six-month trial, people in the abstinence group cut their weekly drinking to an average of two drinks per week, down from 17. The control group also scaled back slightly, reducing their drinks from about 16 to just over 13 per week, on average. Key findings: Afib recurred in 53% of those in the abstinence group, compared with a recurrence rate of 73% among those in the control group. And the time to recurrence was longer among those in the abstinence group.

A well-known association

The new findings are among the first to show a clear association between afib and alcohol intake, says Dr. Zei. But experts have long known that excessive drinking can harm the heart. Binge drinking — defined as consuming about four to five drinks over a two-hour period — can trigger an episode of afib. The phenomenon is known as "holiday heart syndrome" because it typically happens around the holidays and on weekends, when some people drink to excess. The problem can occur in people with or without afib, regardless of how little or how much they typically drink.

"There's evidence that alcohol is toxic to heart muscle cells, which can lead to changes in the heart's blood flow and electrical activity," says Dr. Zei. In addition, longtime heavy drinkers face a heightened risk of cardiomyopathy, a disease of heart muscle that impairs the heart's pumping ability.

Advice about alcohol

Because alcohol is so ingrained in our culture, completely abstaining can be challenging for many people, says Dr. Zei. "However, it's likely that any amount of alcohol poses some risk for triggering afib," he says. He makes sure his patients with afib understand this risk, and he counsels those who enjoy alcohol in moderation to consider cutting back to minimize their risk. For those who are particularly sensitive (that is, they have episodes of afib after drinking even small amounts of alcohol), he recommends complete avoidance.

What else affects afib?

Obesity also makes people more prone to developing afib. But losing even just 10% of your excess weight can help reduce the burden of afib. What's more, weight loss improves at least three other important risk factors for afib (and heart disease in general): high blood pressure, diabetes, and sleep apnea, Dr. Zei notes.

Coffee is another beverage that's commonly linked with afib. However, a recent large observational study found that people who drink one to three cups of coffee daily seem to be less likely to have afib. However, it's possible those results were observed because people with afib are often told to avoid caffeine. As with alcohol, some people are sensitive to caffeine, so avoid it if you notice it affects your heart rate.

Image: © Neustockimages/Getty Images

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https://www.health.harvard.edu/heart-health/can-lifestyle-changes-affect-atrial-fibrillation

2020-03-20 14:49:42Z
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