{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:41:32Z","timestamp":1781286092278,"version":"3.54.1"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Million Veteran Program, Office of Research and Development, Veterans Health Administration","award":["MVP000"],"award-info":[{"award-number":["MVP000"]}]},{"name":"Million Veteran Program, Office of Research and Development, Veterans Health Administration","award":["MVP001"],"award-info":[{"award-number":["MVP001"]}]},{"name":"Million Veteran Program, Office of Research and Development, Veterans Health Administration","award":["MVP009"],"award-info":[{"award-number":["MVP009"]}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"crossref","award":["SDR 02-237"],"award-info":[{"award-number":["SDR 02-237"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"crossref","award":["SDR 98-004"],"award-info":[{"award-number":["SDR 98-004"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>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 \u226440% and HFpEF as heart failure with LVEF \u2265 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\u2013response 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\u201349%). 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\u20130.5, 0.6\u20131, 1.1\u20132, 2.1\u20133, 3.1\u20134 drinks\/day, and heavy drinkers (i.e., &gt;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.<\/jats:p>","DOI":"10.3390\/nu18030471","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T14:12:46Z","timestamp":1770041566000},"page":"471","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Alcohol Intake and Incidence of Heart Failure and Its Subtypes: VA Million Veteran Program"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6299-3763","authenticated-orcid":false,"given":"Xuan-Mai T.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"},{"name":"Department of Medicine, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiman","family":"Elhouderi","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"},{"name":"Department of Medicine, Corewell Health, Grand Rapids, MI 49546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-2748","authenticated-orcid":false,"given":"Yanping","family":"Li","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9061-334X","authenticated-orcid":false,"given":"April R.","family":"Williams","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Gaziano","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brown University, Providence, RI 02912, USA"},{"name":"VA Providence Healthcare System, Providence, RI 02908, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Michael","family":"Gaziano","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Aging, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Cho","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Aging, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9902-3047","authenticated-orcid":false,"given":"Luc","family":"Djousse","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Collaborative, VA Boston Healthcare System, Boston, MA 02111, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA 02115, USA"},{"name":"Division of Aging, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1161\/CIRCRESAHA.121.318172","article-title":"Epidemiology of Heart Failure","volume":"128","author":"Roger","year":"2021","journal-title":"Circ. Res."},{"key":"ref_2","first-page":"e263","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1093\/eurheartj\/ehae362","article-title":"Alcoholic cardiomyopathy: An update","volume":"45","author":"Adler","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5881","DOI":"10.1007\/s11357-025-01613-w","article-title":"Chronic alcohol consumption accelerates cardiovascular aging and decreases cardiovascular reserve capacity","volume":"47","author":"Mukhopadhyay","year":"2025","journal-title":"GeroScience"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.biocel.2017.06.009","article-title":"Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis","volume":"89","author":"Steiner","year":"2017","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/S0140-6736(18)31310-2","article-title":"Alcohol use and burden for 195 countries and territories, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016","volume":"392","author":"Griswold","year":"2018","journal-title":"Lancet"},{"key":"ref_7","unstructured":"CDC (2026, January 16). Alcohol Use and Your Health, Available online: https:\/\/www.cdc.gov\/alcohol\/about-alcohol-use\/index.html."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1093\/eurheartj\/ehu514","article-title":"Alcohol consumption and risk of heart failure: The Atherosclerosis Risk in Communities Study","volume":"36","author":"Claggett","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"181","DOI":"10.7326\/0003-4819-136-3-200202050-00005","article-title":"Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study","volume":"136","author":"Walsh","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(18)30134-X","article-title":"Risk thresholds for alcohol consumption: Combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies","volume":"391","author":"Wood","year":"2018","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s11883-008-0017-z","article-title":"Alcohol consumption and heart failure: A systematic review","volume":"10","author":"Gaziano","year":"2008","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1161\/CIRCHEARTFAILURE.114.002091","article-title":"Regular wine consumption in chronic heart failure: Impact on outcomes, quality of life, and circulating biomarkers","volume":"8","author":"Cosmi","year":"2015","journal-title":"Circ. Heart Fail."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1093\/jn\/131.5.1401","article-title":"Alcohol, Red Wine and Cardiovascular Disease","volume":"131","author":"Wollin","year":"2001","journal-title":"J. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7753","DOI":"10.1038\/s41467-022-35323-0","article-title":"Genetic architecture of heart failure with preserved versus reduced ejection fraction","volume":"13","author":"Joseph","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Patel, Y.R., Robbins, J.M., Kurgansky, K.E., Imran, T., Orkaby, A.R., McLean, R.R., Ho, Y.-L., Cho, K., Michael Gaziano, J., and Djousse, L. (2018). Development and validation of a heart failure with preserved ejection fraction cohort using electronic medical records. BMC Cardiovasc. Disord., 18.","DOI":"10.1186\/s12872-018-0866-5"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4893","DOI":"10.1002\/ehf2.13429","article-title":"Risk factors and prediction models for incident heart failure with reduced and preserved ejection fraction","volume":"8","author":"Gaziano","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_17","unstructured":"US Department of Health and Human Services (2026, January 21). Alcohol and Cancer Risk, Available online: https:\/\/www.hhs.gov\/surgeongeneral\/reports-and-publications\/alcohol-cancer\/index.html."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E31","DOI":"10.5888\/pcd22.240426","article-title":"Nutrition Facts Label Use and Adherence to the DASH Dietary Pattern: Results from a National Health and Nutrition Survey","volume":"22","author":"Lutski","year":"2025","journal-title":"Prev. Chronic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e008089","DOI":"10.1161\/JAHA.117.008089","article-title":"DASH Score and Subsequent Risk of Coronary Artery Disease: The Findings From Million Veteran Program","volume":"7","author":"Ho","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1161\/CIR.0000000000001341","article-title":"Alcohol Use and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"152","author":"Piano","year":"2025","journal-title":"Circulation"},{"key":"ref_21","unstructured":"(2025, July 01). Corporate Data Warehouse (CDW), Available online: https:\/\/www.hsrd.research.va.gov\/for_researchers\/cdw.cfm."},{"key":"ref_22","unstructured":"(2025, July 01). Data Standardization\u2014OHDSI. Available online: https:\/\/www.ohdsi.org\/data-standardization\/."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Yeo, Y., Jeong, S.-M., Shin, D.W., Han, K., Yoo, J., Yoo, J.E., and Lee, S.-P. (2022). Changes in Alcohol Consumption and Risk of Heart Failure: A Nationwide Population-Based Study in Korea. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192316265"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1265\/ehpm.22-00231","article-title":"Alcohol consumption and the risk of heart failure: The Suita Study and meta-analysis of prospective cohort studies","volume":"28","author":"Arafa","year":"2023","journal-title":"Environ. Health Prev. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.clnu.2017.05.007","article-title":"Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies","volume":"37","author":"Larsson","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.ahj.2014.02.014","article-title":"Association between alcohol consumption and systolic ventricular function: A population-based study","volume":"167","author":"Yousaf","year":"2014","journal-title":"Am. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e003116","DOI":"10.1161\/CIRCHEARTFAILURE.115.003116","article-title":"Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes","volume":"9","author":"Ho","year":"2016","journal-title":"Circ. Heart Fail."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.15420\/ecr.2023.12","article-title":"Alcohol and Heart Failure","volume":"18","author":"Rasoul","year":"2023","journal-title":"Eur. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1016\/j.cardfail.2024.04.003","article-title":"Alcohol Consumption and Progression of Heart Failure in Those at Risk for or with Pre-heart Failure","volume":"30","author":"Wong","year":"2024","journal-title":"J. Card. Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.1001\/jama.285.15.1971","article-title":"Moderate Alcohol Consumption and Risk of Heart Failure Among Older Persons","volume":"285","author":"Abramson","year":"2001","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1038\/nrcardio.2015.91","article-title":"Cardiovascular risks and benefits of moderate and heavy alcohol consumption","volume":"12","year":"2015","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Godos, J., Caraci, F., Micek, A., Castellano, S., D\u2019Amico, E., Paladino, N., Ferri, R., Galvano, F., and Grosso, G. (2021). Dietary Phenolic Acids and Their Major Food Sources Are Associated with Cognitive Status in Older Italian Adults. Antioxidants, 10.","DOI":"10.3390\/antiox10050700"},{"key":"ref_33","unstructured":"Humans IWG on the E of CR to (1988). Alcohol Drinking, International Agency for Research on Cancer."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Castaldo, L., Narv\u00e1ez, A., Izzo, L., Graziani, G., Gaspari, A., Minno, G.D., and Ritieni, A. (2019). Red Wine Consumption and Cardiovascular Health. Molecules, 24.","DOI":"10.3390\/molecules24193626"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.amjcard.2005.03.073","article-title":"Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease","volume":"96","author":"Klatsky","year":"2005","journal-title":"Am. J. Cardiol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/3\/471\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T05:11:10Z","timestamp":1770095470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/3\/471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,31]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["nu18030471"],"URL":"https:\/\/doi.org\/10.3390\/nu18030471","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,31]]}}}