Drinking and Smoking in Youth Accelerate Arterial Stiffness

Liam Davenport

August 30, 2021

Adolescents and young adults who smoke and consume alcohol have an accelerated increase in arterial stiffness that could place them at greater risk of cardiovascular disease, suggests a UK analysis.

The researchers examined data on more than 1600 participants in the world-renowned Avon Longitudinal Study of Parents and Children (ALSPAC), which measured arterial stiffness at 17 and 24 years of age.

They found that, overall, arterial stiffness increased during follow-up, but that increase was accelerated with increased alcohol exposure. Similarly, increased intensity of smoking was linked to a relative increase in arterial stiffness, although the effect was seen only in women.

The research was presented at the European Society of Cardiology Congress (ESC) 2021 on August 27.

Reversible Effects

"Smoking and alcohol use in young adulthood are associated with an accelerated increase in arterial stiffness," said study presenter Hugo Walford, a medical student at the Institute of Cardiovascular Science, University College London.

Noting that there was no difference in arterial stiffness between past and never smokers, he added: "These adverse effects may be reversible upon cessation."

"This careful study on a large group of young adult men and women strengthens the evidence that excessive smoking and drinking are associated with increased blood vessel stiffness," Professor Jeremy Pearson told Medscape News UK.

He emphasised that blood vessel thickness "is known to increase the risk of a future heart attack or stroke".

Consequently, "the results reinforce how important early lifestyle choices are in affecting long-term cardiovascular health," added Prof Pearson, who is associate medical director at the British Heart Foundation, which funded the study.

Relatively Small Study

Commenting for the ESC, Dr Silvia Castelletti, said the study is "relatively small", and she would have liked to have seen alcohol use defined in terms of units rather than drinks per day, as "every drink has a different alcohol content".

Dr Castelletti, who is a consultant cardiologist at the Italian Institute for Auxology IRCCS, Milan, Italy, nevertheless said the study is "not so small" and "has the merit of including a large proportion of females".

She believes that this may explain why the significant relationship between arterial stiffness and high intensity smoking was seen only in women.

Also, while it was not studied here, there could be a benefit to alcohol cessation, similar to that seen with stopping smoking.

Dr Castelletti told Medscape News UK that, although she is "not aware of specific studies on alcohol consumption cessation and arterial stiffness", those conducted in heavy alcohol consumers have indicated that "alcohol consumption cessation is associated with a decrease in blood pressure".

Risk Factors

Presenting the study, Mr Walford said that "to prevent cardiovascular disease, it is vitally important to modify lifestyle risk factors, including smoking tobacco and excessive alcohol consumption".

"Adolescence and young adulthood are key periods for initiation and heavy usage of these behaviours, often justified by the belief that they are temporary and come with the freedom of young adulthood."

Mr Walford continued, however, that the "majority of adult heavy smokers and drinkers will have begun these habits in youth, and the early effects of these behaviours on the cardiovascular system are not well understood".

To examine the impact of smoking and alcohol on arterial stiffness in young people, the researchers examined data on 1655 participants in ALSPAC.

The participants, of whom 61% were female, completed questionnaires and underwent assessments including carotid–femoral pulse wave velocity (cfPWV) at ages 17 and 24 years.

Mr Walford said cfPWV is the "gold standard biomarker for arterial stiffness and is a robust predictor of future cardiovascular events, independent of other risk factors".

Participants were then classified based on their level of alcohol consumption, as never, medium (≤4 drinks on a typical day) and high intensity (>5 drinks per day) drinkers.

They were also stratified by their degree of smoking exposure, as never, medium intensity (<10 cigarettes per day) and high intensity (≥10 cigarettes per day). In addition, tobacco users could be classified as past smokers.

Study Findings

The results showed that, between 17 and 24 years of age, cfPWV increased by an average of 0.59 m/s, at 0.56 m/s in women and 0.65 m/s in men (p<0.001).

Each one drink increase in average daily alcohol consumption was associated with a 0.05 m/s increase in cfPWV (p=0.039).

Adjusting for age, sex, and socioeconomic status, the team found that, compared with never users of alcohol (n=116), those who were medium drinkers (n=847) had an average increase in cfPWV of 0.18 (p=0.090), while those with high alcohol exposure (n=679) had an average increase of 0.20 (p=0.055).

These effects were attenuated by further adjustment for systolic blood pressure, body mass index, low density lipoprotein cholesterol, glucose and C-reactive protein levels, but a trend for association remained.

In contrast, there was, compared with never smokers (n=611), no association between arterial stiffness and medium intensity (n=383) and high intensity (n=78) smoke exposure (p=0.400).

However, analysis revealed that there was a relationship between high intensity smoking and arterial stiffness in women, at an increase in cfPWV versus never smokers of 0.32 (p=0.028).

The results also showed that there was no difference in arterial stiffness between never smokers and past smokers (n=580; p=0.50), which, the researchers say, suggests the "adverse effects of smoking in youth may be reversible upon cessation".

The study was funded by the British Heart Foundation.

No relevant financial relationships declared.

ESC Congress 2021: Abstract 82922. Presented 27 August.

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