Separate and Combined Effects of Smoking and Alcohol Abuse in Middle‐aged Men

Abstract

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 7495 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.