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Combined Impact of Alcohol and Tobacco: Implications for Cardiovascular Disease

  • Smoking (Hilary A. Tindle, Section Editor)
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Abstract

Alcohol and tobacco are important modifiable risk factors for prevention of atherosclerosis and cardiovascular disease. There is a strong association between habitual alcohol drinking and smoking. Alcohol shows diverse effects on progression of atherosclerosis mainly through its blood pressure–elevating and high-density lipoprotein (HDL) cholesterol–raising actions. In addition to atherogenic actions, smoking modifies associations between alcohol consumption and cardiovascular risk factors. A positive association of alcohol consumption with blood pressure and inverse associations of alcohol consumption with low-density lipoprotein (LDL) cholesterol and non-HDL cholesterol were more prominent in smokers than in nonsmokers. Both in smokers and nonsmokers, HDL cholesterol tended to be higher with an increase in alcohol consumption. Therefore, blood pressure elevation and LDL cholesterol reduction by drinking are suggested to be greater in smokers than in nonsmokers. Further prospective studies on whether and how smoking influences associations of alcohol consumption with atherosclerotic risk factors and cardiovascular events are needed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006;166:2437–45.

    Article  PubMed  Google Scholar 

  2. Savolainen MJ, Kesäniemi YA. Effects of alcohol on lipoproteins in relation to coronary heart disease. Curr Opin Lipidol. 1995;6:243–50.

    Article  PubMed  CAS  Google Scholar 

  3. Salem RO, Laposata M. Effects of alcohol on hemostasis. Am J Clin Pathol. 2005;123(Suppl):S96–S105.

    PubMed  Google Scholar 

  4. Reynolds K, Lewis LB, Nolen JDL, Kinney GL, Sathya B, He J. Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003;289:579–88.

    Article  PubMed  Google Scholar 

  5. Klatsky AL. Alcohol and cardiovascular disease–more than one paradox to consider. Alcohol and hypertension: does it matter? Yes. J Cardiovasc Risk. 2003;10:21–4.

    Article  PubMed  Google Scholar 

  6. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004;43:1731–7.

    Article  PubMed  CAS  Google Scholar 

  7. Veenstra J, Schenkel JA, van Erp-Baart AM, Brants HA, Hulshof KF, Kistemaker C, et al. Alcohol consumption in relation to food intake and smoking habits in the Dutch National Food Consumption Survey. Eur J Clin Nutr. 1993;47:482–9.

    PubMed  CAS  Google Scholar 

  8. Rehm J, Room R, Monteiro M, Gmel G, Graham K, Rehn N, et al. Alcohol as a risk factor for global burden of disease. Eur Addict Res. 2003;9:157–64.

    Article  PubMed  Google Scholar 

  9. Kawano Y. Physio-pathological effects of alcohol on the cardiovascular system: its role in hypertension and cardiovascular disease. Hypertens Res. 2010;33:181–91.

    Article  PubMed  CAS  Google Scholar 

  10. Omvik P. How smoking affects blood pressure. Blood Press. 1996;5:71–7.

    Article  PubMed  CAS  Google Scholar 

  11. Keil U, Chambless L, Remmers A. Alcohol and blood pressure: results from the Luebeck Blood Pressure Study. Prev Med. 1989;18:1–10.

    Article  PubMed  CAS  Google Scholar 

  12. Keil U, Chambless L, Filipiak B, Härtel U. Alcohol and blood pressure and its interaction with smoking and other behavioural variables: results from the MONICA Augsburg Survey 1984–1985. J Hypertens. 1991;9:491–8.

    Article  PubMed  CAS  Google Scholar 

  13. van Leer EM, Seidell JC, Kromhout D. Differences in the association between alcohol consumption and blood pressure by age, gender, and smoking. Epidemiology. 1994;5:576–82.

    Article  PubMed  Google Scholar 

  14. Wakabayashi I. Modification of the association of alcohol drinking with blood pressure by cigarette smoking. Blood Press. 2008;17:87–93.

    Article  PubMed  Google Scholar 

  15. • Wakabayashi I, Araki Y. Associations of alcohol consumption with blood pressure and serum lipids in Japanese female smokers and nonsmokers. Gend Med. 2009;6:290–9. This was a cross-sectional study using healthy Japanese women on associations of alcohol drinking with blood pressure and blood lipids in smokers (n = 2110) and nonsmokers (n = 14695). Associations of alcohol drinking with both high blood pressure and low LDL cholesterol were stronger in smokers than in nonsmokers, and significant effect of smoking on the relationships of alcohol consumption with systolic and diastolic blood pressure and LDL cholesterol was found. In an analysis using alcohol intake–matched smoker and nonsmoker groups, associations of alcohol intake with high systolic and diastolic blood pressure were observed in smokers but not in nonsmokers.

    Article  PubMed  Google Scholar 

  16. Okubo Y, Suwazono Y, Kobayashi E, Nogawa K. An association between smoking habits and blood pressure in normotensive Japanese men: a 5-year follow-up study. Drug Alcohol Depend. 2004;73:167–74.

    Article  PubMed  Google Scholar 

  17. Barua RS, Ambrose JA, Eales-Reynolds LJ, DeVoe MC, Zervas JG, Saha DC. Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation. J Am Coll Cardiol. 2002;39:1758–63.

    Article  PubMed  CAS  Google Scholar 

  18. Berlin I. Smoking-induced metabolic disorders: a review. Diabetes Metab. 2008;34:307–14.

    Article  PubMed  Google Scholar 

  19. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  PubMed  CAS  Google Scholar 

  20. McInnes GT. Drug treatment of prehypertension: Not now, not ever? Blood Press. 2009;18:304–7.

    Article  PubMed  Google Scholar 

  21. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103:1245–9.

    PubMed  CAS  Google Scholar 

  22. Hajjar IM, Grim CE, George V, Kotchen TA. Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Arch Intern Med. 2001;161:589–93.

    Article  PubMed  CAS  Google Scholar 

  23. Takagi S, Baba S, Iwai N, Fukuda M, Katsuya T, Higaki J, et al. The aldehyde dehydrogenase 2 gene is a risk factor for hypertension in Japanese but does not alter the sensitivity to pressor effects of alcohol: the Suita study. Hypertens Res. 2001;24:365–70.

    Article  PubMed  CAS  Google Scholar 

  24. Wakabayashi I. Age-dependent association of alcohol drinking with pulse pressure. J Hypertens. 2007;25:971–5.

    Article  PubMed  CAS  Google Scholar 

  25. Rimm EB, Williams P, Fosher K, Criqui M, Stampfer MJ. Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. BMJ. 1999;319:1523–8.

    Article  PubMed  CAS  Google Scholar 

  26. Rallidis LS, Pitsavos C, Panagiotakos DB, Sinos L, Stefanadis C, Kremastinos DT. Non-high density lipoprotein cholesterol is the best discriminator of myocardial infarction in young individuals. Atherosclerosis. 2005;179:305–9.

    Article  PubMed  CAS  Google Scholar 

  27. • Wakabayashi I, Groschner K. Age-dependent associations of smoking and drinking with non-high-density lipoprotein cholesterol. Metabolism 2010;59:1074–81. This was a cross-sectional study using 54020 Japanese men aged 20 to 60 years on relationships among smoking, drinking, and non-HDL cholesterol; age-dependent effects on the relationships were also investigated. Smoking was associated with high non-HDL cholesterol in nondrinkers, and drinking was associated with low non-HDL cholesterol in nonsmokers, and these associations were observed at middle and elderly ages but not at a young age. The difference in non-HDL cholesterol between drinkers and nondrinkers was greater in smokers than in nonsmokers.

    Article  PubMed  CAS  Google Scholar 

  28. Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al. Triglycerides and cardiovascular disease: a scientific statement from the American heart association. Circulation 2011;123:2292–333.

    Google Scholar 

  29. Salonen JT, Happonen P, Salonen R, Korhonen H, Nissinen A, Puska P, et al. Interdependence of associations of physical activity, smoking, and alcohol and coffee consumption with serum high-density lipoprotein and non-high-density lipoprotein cholesterol–a population study in eastern Finland. Prev Med. 1987;16:647–58.

    Article  PubMed  CAS  Google Scholar 

  30. Wannamethee G, Shaper AG. Blood lipids: the relationship with alcohol intake, smoking, and body weight. J Epidemiol Community Health. 1992;46:197–202.

    Article  PubMed  CAS  Google Scholar 

  31. Whitehead TP, Robinson D, Allaway SL. The effects of cigarette smoking and alcohol consumption on blood lipids: a dose-related study on men. Ann Clin Biochem. 1996;33:99–106.

    PubMed  Google Scholar 

  32. Wu DM, Pai L, Sung PK, Hsu LL, Sun CA. Joint effects of alcohol consumption and cigarette smoking on atherogenic lipid and lipoprotein profiles: results from a study of Chinese male population in Taiwan. Eur J Epidemiol. 2001;17:629–35.

    Article  PubMed  CAS  Google Scholar 

  33. Wakabayashi I. Associations of alcohol drinking and cigarette smoking with serum lipid levels in healthy middle-aged men. Alcohol Alcohol. 2008;43:274–80.

    PubMed  CAS  Google Scholar 

  34. Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140:211–9.

    PubMed  Google Scholar 

  35. Baliunas DO, Taylor BJ, Irving H, Roerecke M, Patra J, Mohapatra S, et al. Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2009;32:2123–32.

    Article  PubMed  CAS  Google Scholar 

  36. Gulliford MC, Ukoumunne OC. Determinants of glycated haemoglobin in the general population: associations with diet, alcohol and cigarette smoking. Eur J Clin Nutr. 2001;55:615–23.

    Article  PubMed  CAS  Google Scholar 

  37. Harding AH, Sargeant LA, Khaw KT, Welch A, Oakes S, Luben RN, et al. Cross-sectional association between total level and type of alcohol consumption and glycosylated haemoglobin level: the EPIC-Norfolk Study. Eur J Clin Nutr. 2002;56:882–90.

    Article  PubMed  CAS  Google Scholar 

  38. Eliasson B. Cigarette smoking and diabetes. Prog Cardiovasc Dis. 2003;45:405–13.

    PubMed  CAS  Google Scholar 

  39. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2007;298:2654–64.

    Article  PubMed  CAS  Google Scholar 

  40. Chiodera P, Volpi R, Capretti L, Speroni G, Necchi-Ghiri S, Caffarri G, et al. Abnormal effect of cigarette smoking on pituitary hormone secretions in insulin-dependent diabetes mellitus. Clin Endocrinol (Oxf). 1997;46:351–7.

    Article  CAS  Google Scholar 

  41. Wareham NJ, Ness EM, Byrne CD, Cox BD, Day NE, Hales CN. Cigarette smoking is not associated with hyperinsulinemia: evidence against a causal relationship between smoking and insulin resistance. Metabolism. 1996;45:1551–6.

    Article  PubMed  CAS  Google Scholar 

  42. Suter PM. Is alcohol consumption a risk factor for weight gain and obesity? Crit Rev Clin Lab Sci. 2005;42:197–227.

    Article  PubMed  CAS  Google Scholar 

  43. Wakabayashi I. Associations between alcohol drinking and multiple risk factors for atherosclerosis in smokers and nonsmokers. Angiology. 2010;61:495–503.

    Article  PubMed  Google Scholar 

  44. Alkerwi A, Boutsen M, Vaillant M, Barre J, Lair ML, Albert A, et al. Alcohol consumption and the prevalence of metabolic syndrome: a meta-analysis of observational studies. Atherosclerosis. 2009;204:624–35.

    Article  PubMed  CAS  Google Scholar 

  45. Nakanishi N, Takatorige T, Suzuki K. Cigarette smoking and the risk of the metabolic syndrome in middle-aged Japanese male office workers. Ind Health. 2005;43:295–301.

    Article  PubMed  Google Scholar 

  46. Ishizaka N, Ishizaka Y, Toda E, Hashimoto H, Nagai R, Yamakado M. Association between cigarette smoking, metabolic syndrome, and carotid arteriosclerosis in Japanese individuals. Atherosclerosis. 2005;181:381–8.

    Article  PubMed  CAS  Google Scholar 

  47. • Wakabayashi I. Cross-sectional relationship between alcohol consumption and prevalence of metabolic syndrome in Japanese men and women. J Atheroscler Thromb. 2010; 17:695–704. In this cross-sectional study, the relationship between alcohol consumption and metabolic syndrome was investigated using Japanese men (n = 19,398) and women (n = 11,187). Both in male smokers and nonsmokers, light drinking (<22 g/d of ethanol) was associated with low risk of metabolic syndrome. Heavy drinking (>44 g/d of ethanol) was associated with high risk of metabolic syndrome in male nonsmokers but not in male smokers. Both in female smokers and nonsmokers, prevalence of metabolic syndrome tended to be lower in light and heavy drinkers. It seems that there is a gender-related difference in the effect of smoking on the relationship between alcohol consumption and metabolic syndrome.

    Article  PubMed  CAS  Google Scholar 

  48. Ebbert JO, Janney CA, Sellers TA, Folsom AR, Cerhan JR. The association of alcohol consumption with coronary heart disease mortality and cancer incidence varies by smoking history. J Gen Intern Med. 2005;20:14–20.

    Article  PubMed  Google Scholar 

  49. Xu WH, Zhang XL, Gao YT, Xiang YB, Gao LF, Zheng W, et al. Joint effect of cigarette smoking and alcohol consumption on mortality. Prev Med. 2007;45:313–9.

    Article  PubMed  Google Scholar 

  50. Handa K, Tanaka H, Shindo M, Kono S, Sasaki J, Arakawa K. Relationship of cigarette smoking to blood pressure and serum lipids. Atherosclerosis. 1990;84:189–93.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (No. 21390211). The author would like to thank Dr. Klaus Groschner for his helpful suggestions.

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No conflicts of interest relevant to this article were reported.

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Correspondence to Ichiro Wakabayashi.

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Wakabayashi, I. Combined Impact of Alcohol and Tobacco: Implications for Cardiovascular Disease. Curr Cardiovasc Risk Rep 5, 501–509 (2011). https://doi.org/10.1007/s12170-011-0199-8

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