Alcohol use more than doubles risk of MACE in young hypertensive smokers
Alcohol consumption increases the risk of major adverse cardiovascular events (MACE) in stage 1 hypertensive smokers younger than 45 years, a recent study has found.
“Our data indicate that alcohol more than doubles the risk of MACE in young hypertensive smokers, and that the alcohol-related risk is even quadrupled in heavy smokers,” researchers said. “This calls for early surveillance and prompt intervention addressed to improve these unhealthy behaviours.”
A total of 74 fatal and nonfatal MACE occurred during a follow-up of 12.6 years. Multivariable Cox models revealed that current smoking and alcohol drinking correlated with the risk of MACE. [Am J Med 2017;130:967–974.e1]
Based on multivariable model including follow-up changes in blood pressure and body weight, hazard ratio (HR) was 1.48 (95 percent CI, 1.20 to 1.83) for smoking and 1.82 (1.05 to 3.15) for alcohol use. Furthermore, there was an interactive effect between alcohol and smoking on risk of MACE (p<0.001).
The risk of MACE more than doubled among smokers who were alcohol drinkers (n=142; HR, 4.02; 1.98 to 8.15) compared with smokers who abstained from drinking (n=112; HR, 1.64; 0.63 to 4.27). Moreover, the risk of MACE quadrupled among heavy smokers who also drank alcoholic beverages (n=51; HR, 7.79; 4.22 to 14.37).
“In this prospective cohort study of young-to-middle-aged subjects screened for stage 1 hypertension, we observed an interaction of smoking and alcohol on risk of MACE, suggesting that these two factors may have a synergistic effect on the association with cardiovascular disease,” researchers said.
“The association of smoking and alcohol appeared particularly deleterious in heavy smokers, as over one-quarter of these subjects developed one event within the 12.6 years of follow-up, with a sevenfold increase in risk compared with nonsmokers who abstained from drinking,” they added.
Multiple factors, such as genetic and environmental factors, are believed to cause early cardiovascular disease onset. Parental history also significantly predicted MACE in this study, but the combination of smoking and alcohol undermined its prognostic contribution, according to researchers. [J Am Coll Cardio. 2011;57:619–627; Eur J Intern Med 2010;21:511–515; Am J Hypertens 1994;7:7S–12S]
“At least part of the presumed effect of smoking and alcohol use on cardiovascular disease may be due to the risk factors that were adjusted for. However, adjustment for traditional risk factors did not markedly change the associations of smoking and alcohol with risk of adverse outcomes, suggesting that they are direct causal factors in the pathogenesis of MACE,” researchers explained.
These findings stress the importance of these two lifestyle factors in young hypertensive individuals and support the prevention of cardiovascular events through lifestyle changes early in life.
A total of 1,204 untreated patients (mean age 33.1 years) were included in this prospective cohort study. The participants were classified into four categories of cigarette smoking and three classes of alcohol use.
One of the strongest risk factors for cardiovascular disease worldwide is smoking, which also has the largest potential health gains. In addition, alcohol use has been linked to elevated risk of MACE. [J Hypertens 2002;20:1759–1764; BMC Public Health 2016;16:734; Circulation 2016;133:979–987]
More than 60 percent of hypertensive younger adults have stage 1 hypertension, and most of these people are treated with antihypertensive drugs despite lack of evidence about the benefit from drug treatment, according to researchers. [BMJ 2014;349:g5432; Cochrane Database Syst Rev 2012;8:CD006742; JAMA 2013;310:959–968; N Engl J Med 2015;372:447–455]