Older people with newly diagnosed heart failure (HF) may not have to give up their daily glass of beer or wine, according to the results of a study headed by researchers at Washington University School of Medicine in St. Louis. Rather, the study found that newly diagnosed heart failure patients who were aged 65 years or more and consumed seven or fewer alcoholic drinks per week survived on average just over a year longer than individuals who abstained from alcohol.
“My patients who are newly diagnosed with heart failure often ask me if they should stop having that glass of wine every night,” said cardiologist David L. Brown, M.D., a professor of medicine, and senior author of the study, which is published in JAMA Network Open. “And until now, I didn’t have a good answer for them.”
Dr. Brown and colleagues reported the findings of their new study in a paper titled, “Association of Alcohol Consumption After Development of Heart Failure with Survival Among Older Adults in the Cardiovascular Health Study,” in which they concluded, “These findings suggest that limited alcohol consumption among older adults with incident HF is associated with survival benefit compared with long-term abstinence.”
The association between alcohol consumption and heart failure is complex, the authors explained. Excessive drinking can result in heart failure due to alcoholic cardiomyopathy, whereas moderate alcohol consumption has been associated with a reduced risk of incident HF. More recent studies have indicated that consuming more than about seven alcoholic drinks per week is associated with increased risk of heart failure, while consuming less than this has no effect on heart failure risk. However, the team points out, “In contrast to the conflicting data regarding the association between previous alcohol consumption and development of HF, to our knowledge, there are no data regarding the safety of alcohol consumption in patients following a new diagnosis of HF.”
“We have long known that the toxic effects of excessive drinking can contribute to heart failure,” Dr. Brown stated. “In contrast, we have data showing that healthy people who drink moderately seem to have some protection from heart failure over the long term, compared with people who don’t drink at all. But there was very little, if any, data to help us advise people who drink moderately and have just been diagnosed with heart failure.”
Prior studies investigating the effects of alcohol consumption on patients with heart failure have been focused on those with prevalent disease, the researchers commented. “We sought to examine the association between alcohol consumption and survival following the diagnosis of HF in a cohort of older adults in a community setting.”
Dr. Brown’s team analyzed data from the Cardiovascular Health Study, which was conducted between 1989 to 1993, and included 5,888 adults. Of the enrolled participants 393 individuals—average age 79 years—developed heart failure during the nine-year follow-up period. The Washington University School of Medicine team assigned each of the 393 patients into four categories, according to how much alcohol they consumed: those who never drank; those who had been drinkers in the past but who had stopped; those who had seven or fewer drinks per week; and those who consumed eight or more alcoholic drinks per week. “168 participants (42.7%) were abstainers from alcohol use, 96 (24.4%) were former drinkers, 112 (28.5%) were current drinkers consuming seven or fewer drinks per week, and 17 (4.3%) were current drinkers consuming more than seven drinks per week,” the team noted. An alcoholic beverage was defined as a 12-oz beer, a 6-oz glass of wine, or a shot (1.5 ounces) of liquor, and intake was reported by the participants.
Across the four groups, the median survival after diagnosis of heart failure was calculated to be 7.5 years. But after controlling for key variables including age, sex, race, education, income, smoking, blood pressure, diabetes, stroke, and other factors, the researchers found that survival among patients who consumed seven or fewer drinks per week averaged 383 days longer than that of abstainers. This increased survival time in moderate drinkers was statistically significant. In fact, the data suggested that the longest survival time was associated with consuming 10 alcoholic drinks per week, but there were too few patients who drank this amount of alcohol to make definitive conclusions.
“Our findings have potential implications for the 1 million adults aged more than 55 years who are newly diagnosed with HF each year in the United States,” the researchers concluded. “In older patients with incident HF who consumed alcohol before their diagnosis, limited alcohol consumption after the diagnosis appears to be safe … By focusing on individuals with newly diagnosed HF rather than prevalent HF, we reduced the likelihood that any observed associations between alcohol consumption and survival were influenced by survivor bias.”
The team calls for further research to gain further insights into the results. “Given the possibility of health benefits with limited alcohol consumption following this diagnosis, further efforts to determine optimal levels of alcohol consumption in adults with HF and whether this differs by age, sex, left ventricular ejection fraction, or cause of HF are warranted.”
The results should also be interpreted with caution, the authors added. “… the findings should not be used to recommend that individuals who are newly diagnosed with HF should initiate alcohol consumption if they had formerly been abstainers. Likewise, patients with suspected alcohol-induced cardiomyopathy should continue to abstain from alcohol consumption.” The authors point out that the study does have some limitations, and they couldn’t rule out the possibility that uncontrolled confounders had impacted on the results.
“People who develop heart failure at an older age and never drank shouldn’t start drinking,” Dr. Brown said. “But our study suggests people who have had a daily drink or two before their diagnosis of heart failure can continue to do so without concern that it’s causing harm. Even so, that decision should always be made in consultation with their doctors.”
