Coffee, salt, alcohol… What do we know about lifestyle choices and the risk of atrial fibrillation?

Text: Anni Karjala / Image: Erik Lanza There are various known risk factors for atrial fibrillation. As many of these – say family history – can be difficult to modify, we gathered below some essential but modifiable lifestyle factors that impact your risk of getting atrial fibrillation, and what the current scientific evidence says about them. 

1. Coffee

The beloved beverage has been long considered as a risk factor for atrial fibrillation. Recent studies suggest that consuming coffee in moderation – meaning 1-4 cups per day – won’t increase the risk of atrial fibrillation. Some studies have even reported a decrease of the likelihood of getting atrial fibrillation with these amounts (1-3). Drinking coffee more than four cups per day, however, seems to increase the risk. So keep on caffeinating – but in moderation!

2. Physical activity 

Physical activity is no doubt one of the most important habits affecting your heart health. With atrial fibrillation, however, the impact is two-fold. Studies have reported a U-shaped curve on the amount of physical activity and atrial fibrillation, meaning that no physical activity as well as extreme amounts of physical activity may increase the risk for atrial fibrillation (4,5). What, then, is too much? The safe bet is to follow the well-established recommendations for physical activity (5). If you do train excessively, remember to focus on sufficient rest and recovery.

3. Salt 

Skipping salt pays off. Yes, salt is bad for your blood pressure but as it turns out, excessive salt intake also increases the risk of atrial fibrillation (6). As our taste buds are easy to train, try decreasing your salt intake little by little – rather than going cold turkey. 

4. Alcohol

Heavy alcohol consumption increases the risk for atrial fibrillation (7,8).

The recommended amount for women is no more than one drink per day, and no more than two per day for men. However, some recent studies suggest that even just a glass of wine may increase the risk of getting atrial fibrillation (7). So, the less the better! 

5. Tobacco

Smoking is known to increase the risk of atrial fibrillation (9,10). Those who smoke have more than a two-fold risk of atrial fibrillation as compared to those who don’t smoke (9). The good news is that if you kick the habit, the risk for atrial fibrillation will gradually decrease – starting immediately. 

With many risk factors for atrial fibrillation being modifiable, you have a great chance to take ownership of your heart health and improve your odds of avoiding atrial fibrillation. Many of the above-mentioned risk factors contribute also to hypertension and coronary heart disease. By tackling these, you will improve the health of your heart and blood vessels, and increase the likelihood of spending many healthy years with your heart. 

These insights were curated and gathered by Anni Karjala (MD) a doctor who is passionate about cardiology with a focus on digital tools and early intervention. 

References

1) Poole R, Kennedy OJ, Roderick P, Fallowfield JA, Hayes PC, Parkes J. Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes [published correction appears in BMJ. 2018 Jan 12;360:k194]. BMJ. 2017;359:j5024. Published 2017 Nov 22. doi:10.1136/bmj.j50242) Bodar V, Chen J, 2)Gaziano JM, Albert C, Djoussé L. Coffee Consumption and Risk of Atrial Fibrillation in the Physicians' Health Study. J Am Heart Assoc. 2019;8(15):e011346. doi:10.1161/JAHA.118.011346

3) Aleong RG, Sandhu A. Does Coffee Reduce the Risk of Atrial Fibrillation?. J Am Heart Assoc. 2019;8(15):e012862. doi:10.1161/JAHA.119.012862

4)  Jin MN, Yang PS, Song C, et al. Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population. Sci Rep. 2019;9(1):13270. Published 2019 Sep 13. doi:10.1038/s41598-019-49686-w

5) Elliott AD, Mahajan R, Pathak RK, Lau DH, Sanders P. Exercise Training and Atrial Fibrillation: Further Evidence for the Importance of Lifestyle Change. Circulation. 2016 Feb 2;133(5):457-9. doi: 10.1161/CIRCULATIONAHA.115.020800. Epub 2016 Jan 5. PMID: 26733608.

6) Pääkkö TJW, Perkiömäki JS, Silaste ML, Bloigu R, Huikuri HV, Antero Kesäniemi Y, Ukkola OH. Dietary sodium intake is associated with long-term risk of new-onset atrial fibrillation. Ann Med. 2018 Dec;50(8):694-703. doi: 10.1080/07853890.2018.1546054. Epub 2018 Nov 23. PMID: 30442022.

7) Marcus GM, Vittinghoff E, Whitman IR, Joyce S, Yang V, Nah G, Gerstenfeld EP, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Gladstone R, Fan S, Lee E, Fang C, Ogomori K, Fatch R, Hahn JA. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events. Ann Intern Med. 2021 Aug 31. doi: 10.7326/M21-0228. Epub ahead of print. PMID: 34461028.

8) Gallagher C, Hendriks JML, Elliott AD, Wong CX, Rangnekar G, Middeldorp ME, Mahajan R, Lau DH, Sanders P. Alcohol and incident atrial fibrillation - A systematic review and meta-analysis. Int J Cardiol. 2017 Nov 1;246:46-52. doi: 10.1016/j.ijcard.2017.05.133. PMID: 28867013.

9) Chamberlain AM, Agarwal SK, Folsom AR, Duval S, Soliman EZ, Ambrose M, Eberly LE, Alonso A. Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm. 2011 Aug;8(8):1160-6. doi: 10.1016/j.hrthm.2011.03.038. Epub 2011 Mar 15. PMID: 21419237; PMCID: PMC3139831.

10) Zhu W, Yuan P, Shen Y, Wan R, Hong K. Association of smoking with the risk of incident atrial fibrillation: A meta-analysis of prospective studies. Int J Cardiol. 2016;218:259-266. doi:10.1016/j.ijcard.2016.05.013