Illicit Drugs, Acute Alcohol Consumption Linked to First-Time AF

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

In the general population, acute alcohol consumption is associated with an elevated risk for discrete episodes of atrial fibrillation (AF), as well as new-onset AF, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021. The same researchers presented another study at AHA 2021 that demonstrated adults who use methamphetamines, cocaine, opiates, or cannabis may also have a higher risk of developing AF.

For the study assessing the association between acute alcohol consumption and emergency department (ED) visits for AF, researchers at the University of California San Francisco (UCSF) performed an instrumental variable analysis. Blood alcohol concentration measurements obtained through commercially available Bluetooth-enabled breathalyzer devices from individuals in 50 US states were reviewed to identify dates associated with heightened alcohol consumption between January 1, 2014 and December 31, 2016. Then, researchers analyzed data from California’s Office of Statewide Health Planning and Development (SHPD) on ED visits during those dates.

Study outcomes included ED visits with AF for the main analysis or ED visits with supraventricular tachycardia (SVT) as a negative control between January 1, 2005 to December 30, 2015. Researchers also conducted a secondary analysis examining rates of new-onset AF. Population denominators for sex, age, and race/ethnicity in California from the US Census were used. Rates of AF during and 6 days following the instrumental events were compared with all other days of the year using multivariable adjusted Poisson regression models.

Eight recurring events associated with heightened alcohol consumption were identified using 1,269,054 breathalyzer blood alcohol concentration measurements obtained from 36,158 individuals. Multivariable adjustment showed that excess alcohol consumption was associated with 719 additional visits for AF per 100,000 person-years (95% CI, 189-1249; P =.008), while the association with new-onset AF exhibited an even stronger effect (1757 additional visits; 95% CI, 945-2569; P <.001). A negative control analysis of SVT rates during those same dates failed to show a significant increase.

“While we know that alcohol consumption over many years can increase the risk of an ultimate diagnosis of atrial fibrillation, we found evidence that acute alcohol consumption substantially heightens the risk [for] an [ED] visit for atrial fibrillation in the general population,” Sidney Aung, lead author of the aforementioned alcohol-related study, said in an AHA news release. “The study also provided the first objective evidence that acute alcohol consumption increases the risk for a first atrial fibrillation event.”

For their study concerning the association between increased AF risk and methamphetamines, opiates, cocaine, and cannabis, the same researchers analyzed data from California’s SHPD database from January 2005 to September 2015. Out of 23.5 million adult hospitalizations and ED visits, 98,271 cases of methamphetamine use, 48,700 cases of cocaine use, 10,032 cases of opiate use, and 132,834 cases of cannabis use were recorded.

Of methamphetamine users, 31% were women; had a mean age of 35 years; 51% were White individuals, 30% were Hispanic individuals; 6% were Black individuals; and approximately 4% were Asian/Pacific Islander individuals. Of cocaine users, 27% were women; had a mean age of 39 years; 37% were White individuals; 30% were Black individuals; 23% were Hispanic individuals; and almost 3% were Asian/Pacific Islander individuals. Of opiate users, 41% were women; had a mean age of 39 years; greater than two-thirds were White individuals; 19% were Hispanic individuals; 5% were Black individuals; and approximately 3% were Asian/Pacific Islander individuals. Of cannabis users, 27% were women; had a mean age of 32 years; 50% were White individuals; 24% were Hispanic individuals; 16% were Black individuals; and more than 3% were Asian/Pacific Islander individuals.

Those in the study who used the 4 substances and did not experience AF were younger (mean age of 31-39 years), while those who did develop AF were older (mean age of 51-61 years). When compared with data from control participants, who did not use any of the 4 substances, methamphetamine users showed an 86% increased risk for AF. Cocaine users showed a 61% increased risk for AF. Opiate users showed a 74% increase in AF risk. Cannabis users showed a 35% increased risk for AF. The risk for AF increased gradually over time with continued use of each substance.

“Our findings indicate there is still a lot to understand about cardiac arrhythmia and the associated risks with many substances,” Dr Anthony Lin, lead author of the aforementioned illicit drug-related study, said in the AHA news release. “Since the substances analyzed in this study ranged from stimulants to depressants, it was surprising that we were able to observe an increased association of new-onset atrial fibrillation with all four substances.”

Dr Lin noted that “future research should be directed at understanding the physiologic implications of these stimulants and depressants on the heart and strengthening efforts within the health care system to reduce substance abuse disorder.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

Aung S, Nah G, Vittinghoff E, Groh C, Fang C, Marcus GM. Population-level analyses of alcohol consumption as a predictor of acute atrial fibrillation episodes. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Presentation P1221/3046.

Lin A, Nah G, Vittinghoff E, Marcus GM. Substance use and associated risk of incident atrial fibrillation. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Presentation V145.

Illicit drugs, high alcohol consumption both linked to first-time, irregular heart rhythm. News release. American Heart Association. November 8, 2021. Accessed November 10, 2021. https://newsroom.heart.org/news/illicit-drugs-high-alcohol-consumption-both-linked-to-first-time-irregular-heart-rhythm