Abstract
Introduction: While cardiac systolic dysfunction secondary to chronic abuse of alcohol is well described, some evidence suggests a cardiovascular benefit of moderate alcohol consumption. It remains unclear if heavy alcohol consumption predicts congestive heart failure (CHF) in the general population. In addition, the patient characteristics that might influence this relationship remain unknown. Methods and Results: We randomly selected 1 million adults from the California Healthcare Cost and Utilization Project database (capturing all emergency department, ambulatory procedural, and inpatient healthcare encounters) from January 1, 2005 to December 31, 2009. After exclusions for missing demographic information (N=72,301, 7%) and prevalent CHF at study entry (N=69,512, 7%), 858,187 patients were included in the analysis. Analysis variables were defined using ICD-9 codes. During study follow-up, 4% (N=33,046) were coded with alcohol abuse and 12% (N=106,655) developed incident CHF. The mean age was 52 ± 21 years, 35% (N=299,884) were men, and 45% (N=384,204) were white. After adjustment for age, gender, race, hypertension, diabetes, coronary artery disease, chronic kidney disease, valvular heart disease, dyslipidemia, smoking, obesity, obstructive sleep apnea, and income, alcohol abuse was associated with a 70% increased risk of incident CHF (hazard ratio 1.69, 95%CI 1.49-1.91, P<0.001). This relationship was especially strong among younger individuals and those without hypertension ( Figure ). Conclusions: Alcohol abuse was associated with incident CHF in this diverse, population-based cohort. Interaction analyses suggest that the mechanism linking alcohol abuse to development of heart failure may resemble those intrinsic to age related comorbidities and hypertension. Younger individuals and those without hypertension may be disproportionately prone to the myocardial toxic effects of alcohol.
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