Research Article| Volume 32, ISSUE 9, P2187-2194, September 2022

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Smoking and alcohol consumption influence the risk of cardiovascular diseases in Korean adults with elevated blood pressure


      • 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.



      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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