Separate and combined effects of smoking and alcohol abuse in middle-aged men.
Alcohol abuse is a major predictor of premature death, and also an independent risk factor for coronary death. Alcoholics are often heavy smokers. In a large primary prevention trial in middle-aged men with 7,495 participants, registration data were used to identify subjects with alcohol problems. Smokers had slightly lower blood pressure and were somewhat leaner than non-smokers, but had slightly higher serum cholesterol levels. Alcohol-registered subjects also tended to have lower blood pressure levels, and higher serum cholesterol. The relative risk of non-fatal myocardial infarction during the follow-up period of 11.8 years was essentially doubled in smokers compared to non-smokers, regardless of registration for alcohol problems. Among the non-alcoholic subjects, the relative risk of coronary death in smokers was double that of non-smokers, whereas the risk in non-smoking alcoholic subjects was not significantly increased. In smoking alcoholics the relative risk was substantially raised to 4.2 (3.0-7.0; 95% c.i.). In multivariate analysis both smoking and alcohol abuse were independently associated with coronary death. A possible mechanism might be through a combination of tobacco-induced coronary arteriosclerosis and the cardiotoxic effects of alcohol. As to total mortality, a smoking non-alcoholic man had a relative risk of dying almost double that of a non-alcoholic non-smoker. Among non-smoking alcoholics the risk was three times and, in smoking alcoholics over four times that of the non-alcoholic non-smokers.
Rosengren
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A
Department of Internal Medicine, Ostra Hospital, University of Göteborg, Sweden.
Wilhelmsen
L
L
Wedel
H
H
D000367:Age Factors; D000428:Alcohol Drinking; D000437:Alcoholism / Q000150:complications*; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D013548:Sweden