Alcohol Use Increases Cardiovascular and Renal Event Risk among Young-to-Middle-Aged Smokers with Hypertension

To assess the combined impact of alcohol use and smoking on cardiovascular and renal events, researchers analyzed prospective data from 1204 white young-to-middle-aged participants (mean age 33 years, 73% male) with stage 1 hypertension (mean blood pressure 146/94). Alcohol and tobacco use were assessed by interview. The combined major adverse cardiovascular and renal event outcome included fatal and non-fatal myocardial infarction, acute coronary syndromes, cardiac revascularization procedures, hospitalization for heart failure, fatal and non-fatal stroke, aortic or lower limb revascularization, atrial fibrillation, and chronic kidney disease stage 3 or higher.


  • Among the 1204 participants, 74 (6%) had a fatal or non-fatal major adverse cardiovascular and renal event (32 acute coronary syndrome, 11 stroke, 3 heart failure, 3 aortic aneurysm repair, 6 peripheral revascularization, 12 atrial fibrillation, and 7 renal disease) over 12.6 years of follow-up.
  • In unadjusted analyses, smoking and alcohol use (0, <50g/day, 50g/day) were linearly associated with increased risk of adverse outcomes.
  • Any alcohol use, smoking, or combination of alcohol use and smoking were associated with increased risk of adverse outcomes in adjusted models (Table).


Table. Hazard ratio (95% confidence interval) of adjusted* models for substance use groups** (reference group: nonsmokers who did not drink alcohol)  



Any Alcohol Use


Any Smoking


Any Alcohol Use + Any Smoking

Heavy Smoking

(> 10 cigs/d) + Any Alcohol Use

Major adverse cardiovascular and renal event, including atrial fibrillation 1.8 (1.1 – 3.2) 1.5 (1.2 – 1.8) 4.0 (2.0 – 8.2) 7.8 (4.2 – 14.4)
Major adverse cardiovascular and renal event, without atrial fibrillation 2.3 (1.2 – 4.3)

1.5 (1.2 – 1.9)

7.3 (3.8 – 14.1)

* Models adjusted for age, sex, coffee intake, physical activity, body mass index, family history of cardiovascular disease, glucose, lipids, average 24-hour blood pressure, incident hypertension, and longitudinal changes in blood pressure and body weight.

** Any alcohol use (n=569), any smoking (n=254), any alcohol use + any smoking (n=142), any alcohol use + heavy smoking (n=51).

Comments: This study suggests an interactive effect between alcohol use and smoking to increase risk for cardiovascular and renal events in hypertensive smokers 45 years old or younger. The outcome variable is quite heterogeneous so it is difficult to know which specific cardiovascular events are most susceptible to the combination of smoking and drinking. Further, adjusted results were not presented for levels of drinking. Nonetheless, the results support existing clinical recommendations to control blood pressure and encourage tobacco cessation and lower-risk (which includes no) drinking.

Kevin L. Kraemer, MD, MSc

Reference: Palatini P, Fania C, Mos L, et al. Alcohol intake more than doubles the risk of early cardiovascular events in young hypertensive smokers. Am J Med. 2017;130(8):967-974.e1.

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