Abstract 10983: Alcohol Intake and Heart Failure Incidence: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Background: Alcohol intake has a well-described J-shaped effect on cardiovascular disease and all-cause mortality. Previous studies have shown a lower incidence of heart failure (HF) with moderate alcohol use. However, it is unknown whether alcohol intake is associated with a lower incidence of HF with reduced ejection fraction (HFrEF) or with preserved ejection fraction (HFpEF). Methods: We performed analyses of participants from the Multi-Ethnic Study of Atherosclerosis (MESA) to assess the association of alcohol and incident HF. Alcohol use was determine by self-report at baseline. Individuals were free of cardiovascular disease at baseline and were followed for a mean of 10.2 ± 2.8 years for incident events. Heart failure was classified as HFrEF (ejection fraction (EF) ≤50%) or HFpEF (EF > 50%) at the time of HF diagnosis. We performed time-fixed Cox proportional hazard regression models to assess associations between alcohol use and incident heart failure. Analyses were adjusted for age, sex, race, smoking (pack-years), and education, and then additionally for systolic and diastolic blood pressures, use of antihypertensive medications, family history of CHD, diabetes, HDL-cholesterol, C-reactive protein, fibrinogen, and interim myocardial infarction as a time-varying covariate. Results: We identified 6,763 individuals with alcohol use data, which included 1,390 (20.6%) never, 1,624 (24.0%) former, and 3,749 (55.4%) current drinkers at baseline. The average age was 62.1 years with 47.2% men. There were 258 HF events with 118 classified as HFrEF, 112 as HFpEF, and 28 participants excluded from analyses due to an unknown EF. Compared to never drinkers, individuals reporting > 2 drinks per day had a higher risk of developing HFpEF [HR 2.41 (95% CI 1.04, 5.60) in model 1 and HR: 2.65 (1.10-6.42) in the fully adjusted model]. There were no significant associations between alcohol use and incident overall HF (HFpEF and HFrEF combined) [HR 1.31 (0.73-2.35)] or HFrEF [HR 0.78 (0.32-1.92)]. Conclusion: In the MESA cohort, individuals who drank greater than 2 alcoholic drinks per day had an increased odds of incident HFpEF but not HFrEF. Follow-up studies are needed to understand the etiology of these differences and to investigate for differences by race and sex.