- •Smoking is significantly associated with the risk of cardiovascular disease (CVD).
- •Alcohol consumption is significantly associated with the risk of CVD.
- •Women have greater risk of CVD than do men among Korean adults with elevated BP.
Background and aims
Cardiovascular disease (CVD) and hypertension are the main causes of global death. We aimed to investigate the independent and combined effects of smoking and alcohol consumption on CVD risk among Koreans with elevated blood pressure (BP).
Methods and results
Adults aged 20–65 years with elevated BP and without pre-existing CVDs were selected from the National Health Insurance Service-National Sample Cohort version 2.0. We followed up 59,391 men and 35,253 women between 2009 and 2015. The association of CVD incidence with smoking pack-years and alcohol consumption was investigated using the multivariate Cox proportional hazard model. Among women, smokers (10.1–20.0 pack-years) and alcohol drinkers (≥30.0 g/day) had higher CVD risks (hazard ratio [HR] = 1.15, 95% confidence intervals [CI] 1.06–1.25, HR = 1.06, 95% CI 1.00–1.12, respectively) compared to each referent group. However, men who smoked exhibited an increased CVD risk only with pack-years >20.0 (HR = 1.09, 1.03–1.14 and HR = 1.18, 1.11–1.26 for smokers with 20.1–30.0 and ≥ 30.1 pack-years, respectively) compared to nonsmokers. In the combined groups of those smoking and consuming alcohol, only nonsmoking men consuming alcohol 1.0–29.9 g/day had a lower CVD risk than did nonsmoking, nondrinking men (HR = 0.90, 0.83–0.97). Women smoking 1.0-10.0 pack-years and consuming alcohol ≥30.0 g/day had a higher CVD risk (HR = 1.25, 1.11–1.41) than nonsmoking and nondrinking women.
Smoking and alcohol consumption, independently and jointly, were associated with CVD risk in men and women. Women had a greater CVD risk than did men among Korean adults with elevated BP.
Abbreviations:CVD (Cardiovascular disease), BP (Blood pressure), NHIS-NSC 2.0 (National Health Insurance Service-National Sample Cohort version 2.0), ICD (International Classification of Diseases), T2D (Type 2 diabetes), BMI (Body mass index), FBG (Fasting blood glucose), NSND (Nonsmoking nondrinking), HR (Hazard ratio), CI (Confidence interval)
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Published online: June 10, 2022
Accepted: June 6, 2022
Received in revised form: May 24, 2022
Received: November 20, 2021Handling Editor: Dr. A. Siani
© 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.