Rosengren A, Wilhelmsen L, Wedel H
Department of Internal Medicine, Ostra Hospital, University of Göteborg, Sweden.
Acta Med Scand. 1988;223(2):111-8. doi: 10.1111/j.0954-6820.1988.tb15774.x.
Alcohol abuse is a major predictor of premature death, and also an independent risk factor for coronary death. Alcoholics are often heavy smokers. In a large primary prevention trial in middle-aged men with 7,495 participants, registration data were used to identify subjects with alcohol problems. Smokers had slightly lower blood pressure and were somewhat leaner than non-smokers, but had slightly higher serum cholesterol levels. Alcohol-registered subjects also tended to have lower blood pressure levels, and higher serum cholesterol. The relative risk of non-fatal myocardial infarction during the follow-up period of 11.8 years was essentially doubled in smokers compared to non-smokers, regardless of registration for alcohol problems. Among the non-alcoholic subjects, the relative risk of coronary death in smokers was double that of non-smokers, whereas the risk in non-smoking alcoholic subjects was not significantly increased. In smoking alcoholics the relative risk was substantially raised to 4.2 (3.0-7.0; 95% c.i.). In multivariate analysis both smoking and alcohol abuse were independently associated with coronary death. A possible mechanism might be through a combination of tobacco-induced coronary arteriosclerosis and the cardiotoxic effects of alcohol. As to total mortality, a smoking non-alcoholic man had a relative risk of dying almost double that of a non-alcoholic non-smoker. Among non-smoking alcoholics the risk was three times and, in smoking alcoholics over four times that of the non-alcoholic non-smokers.
酗酒是过早死亡的主要预测因素，也是冠心病死亡的独立危险因素。酗酒者往往也是重度吸烟者。在一项有7495名中年男性参与的大型一级预防试验中，利用登记数据来识别有酒精问题的受试者。吸烟者的血压略低，体重比不吸烟者稍轻，但血清胆固醇水平略高。登记有酒精问题的受试者血压水平也往往较低，血清胆固醇较高。在11.8年的随访期内，吸烟者发生非致命性心肌梗死的相对风险与不吸烟者相比基本翻倍，无论是否登记有酒精问题。在非酗酒受试者中，吸烟者冠心病死亡的相对风险是不吸烟者的两倍，而不吸烟的酗酒者风险没有显著增加。在吸烟的酗酒者中，相对风险大幅升至4.2（3.0 - 7.0；95%置信区间）。在多变量分析中，吸烟和酗酒都与冠心病死亡独立相关。一种可能的机制可能是烟草诱导的冠状动脉硬化与酒精的心脏毒性作用相结合。至于总死亡率，吸烟的非酗酒男性死亡的相对风险几乎是不吸烟的非酗酒男性的两倍。在不吸烟的酗酒者中，风险是其三倍，而在吸烟的酗酒者中，风险是不吸烟的非酗酒者的四倍多。
