Physicians' Academy for Cardiovascular Education

Higher smoking exposure and alcohol consumption associated with increased arterial stiffness in adolescents

Early vascular damage from smoking and alcohol in teenage years: the ALSPAC study

Literature - Charakida M, Georgiopoulos G, Dangardt F et al. - Eur Heart J 2018; doi:10.1093/eurheartj/ehy52

Introduction and methods

Cigarette smoking and alcohol consumption are positively associated with CV risk in adults [1-2]. Moreover, smokers have a two-fold risk of suffering a myocardial infarction compared to non-smokers, whereas the dose-effect relationship of alcohol intake and CV risk remains contradictory [3]. Most adults who use alcohol or tobacco begin in their early teenage years [4,5]. This study assessed the impact of smoking and alcohol exposure on arterial stiffness in young adulthood.

This sub-analysis of the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort study included 1266 participants with measured carotid-to-femoral pulse wave velocity (PWV) at 17 years and data on both smoking exposure and alcohol use at 13, 15 and 17 years.

Smoking exposure and alcohol consumption were measured by questionnaires. Participants were classified by smoking status (smokers and non-smokers), and intensity in lifetime smoking (high [>100 cigarettes], moderate [20–99 cigarettes], and low/never smokers [<20 cigarettes]). For alcohol use, participants were classified by frequency (drinkers and not-drinkers), and intensity of drinking (heavy [>10 drinks], medium [3-9 drinks], and light [<2 drinks]) on a typical day that they were drinking alcohol. The outcome was aortic stiffness, measured by carotid to femoral PWV.

Main results

Smoking behavior

Alcohol consumption

Smoking exposure and alcohol consumption


Drinking intensity and smoking was independently and additively associated with arterial changes relevant to atherosclerosis progression in adolescents in a large cohort study. Interestingly, an association between smoking cessation and normalization of aortic stiffness in adolescence was observed. These results provide further support to discourage young adults adopting smoking and drinking habits, and discontinue these unhealthy behaviors.

Editorial comment

In their editorial [6], Münzel, Hahad and Daibe characterize the Charakida et al. data as ‘somewhat surprising’ and ‘worrisome’ since the numbers of cigarettes smoked by teenagers are far below those considered to be harmful in adults. They note that the interpretation of the results would have been easier if the nicotine degradation product cotinine was measured, rather than subjective questionnaire-based assessment. Next, they discuss how politicians and healthcare providers can protect young adults from smoking- and alcohol-driven vascular damage, including the provision of age verification systems on cigarette machines, ban of tobacco smoking in public areas and prohibition of cigarette advertising.


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