Trending Clinical Topic: Alcohol

Ryan Syrek


June 04, 2021

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New studies on the health impacts of alcohol consumption have been released (see Infographic below) at a time when drinking is on the rise, resulting in this week's top trending clinical topic. One of the largest studies on alcohol and brain health ever undertaken found that consuming any amount of alcohol is associated with poorer brain health. The study, which has not yet been peer reviewed, included more than 25,000 adults: 691 never-drinkers, 617 former drinkers, and 24,069 current drinkers. After adjusting for all known potential confounders, a higher volume of alcohol consumed per week was associated with less gray matter in nearly all brain areas. Widespread negative associations were also found between drinking alcohol and all measures of white matter integrity that were assessed. Regarding interpretation of the results, experts caution that the extent to which minor reductions in brain volume is significantly harmful remains unclear.

A separate study examined reported benefits of alcohol among patients with cardiovascular disease. Results showed two J-shaped relationships: one between alcohol intake and major adverse cardiovascular events (MACE), and another between alcohol intake and stress-associated amygdalar metabolic activity. Compared with those who had low alcohol intake (less than one drink per week) or high alcohol intake (more than 14 drinks per week), those who had moderate alcohol intake (1-14 drinks per week) were less likely to have MACE events and had less amygdalar activity on imaging. After robustly controlling for confounders, researchers found a 20% reduction in MACE among those with moderate alcohol intake. The current study also showed, for the first time, that moderate alcohol intake was associated with reduced stress-associated brain activity, which may explain some of the benefit regarding cardiovascular outcomes.

In less encouraging news regarding heart health, even one drink was found to increase the likelihood that an episode of atrial fibrillation (AF) will occur within a few hours; the more alcohol consumed, the higher the risk. The study showed that consuming any alcoholic beverage was associated with more than twofold greater odds of an AF event in the subsequent 4 hours, and two or more drinks were linked to more than a threefold higher risk. Although the highest risk was observed within the first 3-4 hours after drinking, the effects lasted nearly 9 hours. 

Another recent study by the same investigators provides some biologic plausibility. It demonstrated that patients with AF who drank alcohol had a substantial reduction in the pulmonary vein atrial effective refractory period, which would probably render their atria more prone to fibrillate. Studies have also shown that advising drinkers with AF to abstain from alcohol results in fewer AF episodes.

Moving beyond the head and heart, alcohol's effects on other aspects of health remain a concern. GI and liver diseases associated with drinking dramatically increased during the pandemic. In comparing with the same period in 2019, researchers found that although the overall number of people seeking GI or liver specialist care dropped by 27%, the proportion of consults for alcohol-related GI and liver diseases jumped by nearly 60%. Statistics like these have prompted some experts to question whether physicians are ready for the health impacts of the "alcohol pandemic." The fact that the subject is this week's top trending clinical topic shows that many are paying close attention.

Read more about alcohol toxicity.


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