Combined Impact of Alcohol and Tobacco: Implications for Cardiovascular Disease
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SMOKING (HILARY A. TINDLE, SECTION EDITOR)
Combined Impact of Alcohol and Tobacco: Implications for Cardiovascular Disease Ichiro Wakabayashi
Published online: 27 September 2011 # Springer Science+Business Media, LLC 2011
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. Keywords Alcohol . Atherosclerosis . Diabetes mellitus . Hypertension . Dyslipidemia . Smoking
Introduction Alcohol drinking is known to diversely influence the risk for atherosclerotic diseases. The risk for cardiovascular I. Wakabayashi (*) Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan e-mail: [email protected]
diseases, especially coronary heart disease, is lower in lightto-moderate drinkers than in nondrinkers [1], and this relationship is mainly explained by actions of alcohol on blood lipid levels, such as high-density lipoprotein (HDL) cholesterol–raising and low-density lipoprotein (LDL) cholesterol–lowering actions [2]. Inhibition of platelet aggregation and alteration in blood coagulation-fibrinolysis balance are also involved in the decrease in the risk for thrombotic arterial diseases [3]. On the other hand, excessive alcohol drinking causes an increase in the risk for cardiovascular diseases, especially hemorrhagic stroke, such as cerebral hemorrhage and subarachnoid hemorrhage [4]. This harmful effect of drinking is mainly explained by alcoholinduced hypertension [5]. Smoking is known to be a major risk factor for atherosclerotic disease. The atherogenic effect of smoking is mediated by a variety of mechanisms [6]: (1) smoking causes a decrease in vascular nitric oxide availability, resulting in impairment of vasodilatory function; (2) smoking facilitates inflammatory response on the arterial wall through an increase in the peripheral blood leukocyte count, elevation of proinflammatory cytokines, and activation of proatherogenic molecules leading to ce
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