title: Alcohol Intake More than Doubles the Risk of Early Cardiovascular Events in Young Hypertensive Smokers.
abstract: An interactive effect of tobacco and alcohol use has been described for cancer. The aim of this study was to investigate the joint effect of smoking and alcohol intake on major adverse cardiovascular and renal events (MACE) in young subjects screened for stage 1 hypertension.
  
  
  
  A total of 1204 untreated patients aged from 18 to 45 years (mean 33.1) were included in this prospective cohort study. Subjects were classified into 4 categories of cigarette smoking and 3 classes of alcohol use. Main outcome variable was risk for MACE.
  
  
  
  During a 12.6-year follow-up, there were 74 fatal and nonfatal MACE. In multivariable Cox models, current smoking and alcohol drinking were associated with risk of MACE. In a multivariable model also including follow-up changes in blood pressure and body weight, hazard ratio (HR) was 1.48 (95% confidence interval [CI], 1.20-1.83) for smoking and was 1.82 (95% CI, 1.05-3.15) for alcohol use. In addition, an interactive effect was found between smoking and alcohol on risk of MACE (P <.001). Among the 142 smokers who also drank alcoholic beverages, the risk of MACE (HR 4.02; 95% CI, 1.98-8.15) was more than doubled compared with the 112 smokers who abstained from drinking (HR 1.64; 95% CI, 0.63-4.27). In the group of heavy smokers who also were alcohol drinkers (n = 51), the risk of MACE was even quadrupled (HR 7.79; 95% CI, 4.22-14.37).
  
  
  
  Alcohol use potentiates the deleterious cardiovascular effects of heavy smoking in stage 1 hypertensive subjects younger than 45 years. These results call for prompt intervention addressed to improve unhealthy behaviors in these subjects.
authors.affiliation: Department of Medicine, University of Padova, Italy. Electronic address: palatini@unipd.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palatini
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Fania
authors.affiliation: Town Hospital, San Daniele del Friuli, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Mos
authors.affiliation: Town Hospital, Vittorio Veneto, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Mazzer
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saladini
authors.affiliation: Department of Medicine, University of Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000428:Alcohol Drinking / Q000009:adverse effects*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D003069:Coffee / Q000009:adverse effects*; D004347:Drug Interactions; D015444:Exercise; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007558:Italy; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D003069:Coffee
keywords: Alcohol; Cardiovascular; Hypertension; Longitudinal study; Risk; Smoking