Combined Impact of Alcohol and Tobacco: Implications for Cardiovascular Disease

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.