The relationship between alcohol consumption and atrial fibrillation (AF) risk remains clinically relevant, particularly because guideline recommendations provide limited quantitative thresholds for alcohol intake. A systematic review and network meta-analysis published in Europace evaluated the dose-response association between varying levels of alcohol consumption and incident AF.

The analysis included 26 studies involving nearly 15 million participants with a weighted mean follow-up of approximately 6.4 years. Alcohol intake categories ranged from very low (<12 g/day) to very high (>60 g/day). Pairwise and network meta-analyses were performed to compare AF risk across predefined intake levels.

Findings

• Compared with no alcohol intake, very high alcohol consumption (>60 g/day) was associated with a 75% higher risk of incident AF (RR 1.75; 95% CI 1.25–2.44; p=0.04).
• Alcohol intake below 48 g/day was not associated with excess AF risk relative to no intake in the pairwise analysis.
• The lowest relative AF risk was observed among individuals consuming less than 12 g/day of alcohol (RR 0.72; 95% CI 0.63–0.83).
• Network meta-analysis showed higher AF risk with very high alcohol intake compared with low (RR 1.91), moderate (RR 2.03), and high intake levels (RR 2.00).
• Sex-stratified analyses demonstrated similar dose-response patterns in men and women.

The analysis identified a nonlinear association between alcohol intake and incident AF, with significantly higher risk observed at consumption levels above 60 g/day.