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

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 smok-ing 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 IHR] = 1.15, 95% confi-dence intervals ICI] 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 smok-ing 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. Conclusion: 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.(c) 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Ital-ian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.