Alcohol, caffeine are common triggers of irregular heart rhythm: study

The most common triggers of atrial fibrillation - an irregular heart rhythm that’s a
leading cause of stroke - are avoidable behaviors like drinking alcohol or coffee, a
recent study suggests.
People don’t always realize when they’re experiencing atrial fibrillation, or AFib,
but some feel unpleasant chest palpitations or a racing, irregular heartbeat.
Some patients have AFib 24 hours a day. In others, the irregular heartbeat is
“paroxysmal,” that is, it comes and goes. For the current study, reported in the
journal Heart Rhythm, researchers surveyed 1,295 patients with symptomatic
paroxysmal AFib and found the most common behaviors that triggered episodes of
the arrhythmia were alcohol consumption, caffeine consumption and exercise.
The survey asked about 11 possible triggers: alcohol, caffeine, lack of sleep,
exercise, not exercising, consuming cold beverages, consuming cold foods, high
sodium diet, consuming large meals, dehydration, and lying on one’s left side.
About three-fourths of the patients said at least one of those behaviors triggered
AFib some or all of the time.
Alcohol consumption was cited by 35 percent, followed by coffee drinking (28
percent), exercise (23 percent) and lack of sleep (21 percent).
The researchers say it’s possible the behaviors don’t actually trigger the episodes
but instead make the symptoms worse.
The study wasn’t designed to tell whether cutting back on these triggers would
reduce the frequency of AFib episodes.
Still, coauthor Dr. Gregory Marcus from University of California, San Francisco
told Reuters Health, “Many, if not most of these triggers are modifiable, and we
feel theoretically the patient does have some power to potentially influence the
probability of an episode occurring.”
Dr. Deepak Bhat, a cardiologist at Brigham and Women’s Hospital Heart &
Vascular Center in Boston who was not associated with the study, agreed. He told
Reuters Health by phone, “Importantly, the information in this paper is actionable.
People with episodes of atrial fibrillation that appear to be triggered by alcohol or
caffeine, for example, can avoid these.”
Associations between alcohol and AFib are well known, but the link with coffee is
controversial, Bhat said. “Some experts dispute that association . . . though I have
seen it in many patients,” he added.
Bhat noted that while exercise is a healthy habit, strenuous exercise after long
periods of not exercising has been known to trigger heart arrhythmias.
Marcus said the idea for the research came from a summit that brought together
patients and researchers to identify topics patients thought were not well covered
by the scientific community. Patients with atrial fibrillation unanimously agreed
that they wanted to know more about triggers.
“While there has been quite a bit of research investigating the root cause of the first
diagnosis of (AFib), there has not been sufficient investigation into understanding
why an episode happens when it happens,” Marcus said.
In AFib, the heart’s two small upper chambers beat irregularly and too fast,
“quivering like a bowl of gelatin,” according to the American Heart Association.
As a result, the heart can’t pump properly and the body doesn’t get enough
oxygen-carrying blood. AFib can lead to serious medical problems including
stroke and heart failure. Treatments include medication to regulate the heart rate or
heart rhythm, blood thinners to help prevent clots from forming, and in some cases,
electric shocks to reset the beat of the heart.
What's bad for the heart is also bad for the brain

People who have risk factors for heart disease like diabetes, high blood pressure
and obesity may also be more likely to develop structural changes in the brain that
can lead to dementia, a recent study suggests.
Researchers examined data on 9,772 adults, ages 44 to 79, who all had at least one
MRI brain scan and provided general health information and medical records for
the analysis.
The researchers looked for associations between brain structure and so-called
vascular risk factors. They found that except for high cholesterol, all of the other
vascular risk factors - smoking, high blood pressure, high pulse pressure, diabetes,
and obesity - were linked to abnormal brain changes seen in dementia.
And the more vascular risk factors a person had, the poorer was their brain health,
as evidenced by greater brain shrinkage, less gray matter (tissue mainly on the
surface of the brain) and less healthy white matter (tissue in deeper parts of the
brain).
“There are some things that contribute to cognitive and brain aging that we cannot
change (like our genes), so you could look at this like a list of things that we can
have some agency over - so-called ‘malleable’ risk factors,” said lead study author
Simon Cox of the University of Edinburgh in the U.K.
“There are so many other benefits to improving your cardiovascular health
(improving diet, weight, exercise, blood sugar control) and stopping smoking, but
in combination with other good evidence out there, maintaining brain health is
probably another one,” Cox said by email.
The strongest links between the vascular risk factors and brain structure were in
areas of the brain known to be responsible for our more complex thinking skills,
and which deteriorate during the development of Alzheimer’s disease and
dementia.
Risk factors for heart disease appeared to impact brain health just as much in
middle age as they did later in life, researchers report in the European Heart
Journal.
And the risk of structural changes in the brain associated with cognitive decline
also increased with each additional vascular risk factor, even in adults who
appeared otherwise healthy, the study found.
Smoking, high blood pressure and diabetes were the three vascular risk factors that
showed the most consistent associations across all types of brain tissue. High
cholesterol levels were not associated with any differences in the MRI scans.
The study wasn’t a controlled experiment designed to prove whether or how
specific risk factors might directly cause dementia or cognitive decline.
“The precise mechanisms underlying these findings are not entirely clear,” said Dr.
Jeffrey Burns, co-director of the University of Kansas Alzheimer’s Disease Center.
“The findings do underscore our increasing recognition that dementia is a complex
syndrome and that vascular factors contribute to brain changes that we see and
expect in people who are diagnosed with Alzheimer’s disease,” Burns, who wasn’t
involved in the study, said by email.
Still, there’s enough evidence of the connection for patients to do what they can to
promote brain health as they age, said Dr. Andrew Budson of the Veterans Affairs
Boston Healthcare and Boston University School of Medicine.
“Because smoking, hypertension, and diabetes were the strongest risk factors, if
you have a number of risk factors, these are the most important ones to work on,”
Budson, who wasn’t involved in the study, said by email.
“Quit smoking cigarettes today,” Budson advised. “Control high blood pressure
and diabetes through medications, aerobic exercise, and weight loss. These
measures can reduce the daily brain damage that will otherwise occur.”