# Alcohol Intake and Incidence of Heart Failure and Its Subtypes: VA Million Veteran Program

## TL;DR

This study finds that moderate alcohol consumption is linked to a lower risk of heart failure in veterans, but heavy drinking increases the risk.

## Contribution

The study identifies a J-shaped relationship between alcohol consumption and heart failure risk in veterans, including subtype-specific associations.

## Key findings

- Moderate alcohol consumption is associated with reduced heart failure risk compared to never drinkers.
- Heavy drinking significantly increases the risk of heart failure with reduced ejection fraction.
- Type of alcoholic beverage consumed does not influence heart failure risk.

## Abstract

Background: Little is known about the relation between total alcohol intake and beverage types with the risk of heart failure (HF) and its subtypes in the veteran population. This study aims to examine the associations between total and type of alcohol consumption and risk of HF and its subtypes, namely HF with reduced [HFrEF] and preserved [HFpEF] ejection fraction, in a large cohort of US veterans. Methods: The study cohort included 401,348 Million Veteran Program participants with complete alcohol information collected through a survey and no HF at baseline. HF events were defined as 1 inpatient or 1 outpatient diagnosis code together with at least two ejection fraction (EF) measurements. We defined HFrEF as HF with left ventricular ejection fraction (LVEF) of ≤40% and HFpEF as heart failure with LVEF ≥ 50%. The associations between alcohol intake, type of beverage consumed (i.e., beer, wine, or liquor), and incidence of HF, HFpEF, and HFrEF were assessed using Cox proportional hazard models. Restricted cubic spline regression was used to assess for a dose–response association between alcohol consumption and the risk of HF. Results: Mean age was 65 years, and 91% were men. With a mean follow-up of 6.4 years, we observed 38,420 incident HF events (15,356 HFrEF, 19,047 HFpEF, and 4017 HF with an EF value of 41–49%). Compared to never drinkers, multivariable adjusted hazard ratios for HF were 0.90 (95% CI: 0.86, 0.94), 0.88 (95% CI: 0.84, 0.93), 0.86 (95% CI: 0.81, 0.91), 0.92 (95% CI: 0.86, 0.98), 0.95 (95% CI: 0.84, 1.06), and 1.08 (95% CI: 1.01, 1.15) for current drinkers of 0.1–0.5, 0.6–1, 1.1–2, 2.1–3, 3.1–4 drinks/day, and heavy drinkers (i.e., >4 drinks/day and/or those diagnosed with alcohol use disorder), respectively. We found a similar association between alcohol intake and risk of HFpEF and HFrEF, except heavy drinking was significantly associated with HFrEF (HR: 1.13, 95% CI: 1.02, 1.24), not HFpEF (HR: 1.05, 95% CI: 0.96, 1.13). Types of alcoholic beverage preference did not influence the alcohol-HF relation. Conclusions: Our data are consistent with a J-shaped relation between alcohol consumption and risk of heart failure, irrespective of subtypes.