The content of this website is intended for healthcare professionals only

Smoking and drinking can damage arteries 'early in life'

Arteries of teenagers who drink alcohol and smoke, even occasionally, are beginning to stiffen by 17

Ingrid Torjesen

Wednesday, 29 August 2018

The arteries of teenagers who drink alcohol and smoke, even very occasionally, are already beginning to stiffen by age 17, according to research* published in the European Heart Journal.

The findings showed that a combination of high alcohol intake and smoking was linked to greater arterial damage compared to drinking and smoking separately.

The researchers analysed data from 1,266 adolescents from Children of the 90s, the Avon Longitudinal Study of Parents and Children (ALSPAC), over a five-year period between 2004 and 2008.

Participants provided details of their smoking and drinking habits at ages 13, 15 and 17. Aortic stiffening was then assessed using a Vicorder device to measure carotid-femoral pulse wave velocity (the speed at which the arterial pulse propagates through the circulatory system).

"We found that in this large contemporary British cohort, drinking and smoking in adolescence, even at lower levels compared to those reported in adult studies, is associated with arterial stiffening and atherosclerosis progression," said senior author, Professor John Deanfield (UCL Institute of Cardiovascular Science).

"However, we also found that if teenagers stopped smoking and drinking during adolescence, their arteries returned to normal suggesting that there are opportunities to preserve arterial health from a young age."

Participants recorded the number of cigarettes they had ever smoked and were grouped by intensity from "low" (0-20 cigarettes) to "moderate" (20-99 cigarettes) to "high" (more than 100 cigarettes). Exposure to parental smoking was also assessed by questionnaires.

Teenagers in the “high” intensity smoking group had a relative increase of 3.7% in the stiffening of their arteries (measured by mean increase in pulse wave velocity) compared to those in the “low” smoking intensity group.

Participants also reported the age they started drinking alcohol and the frequency and intensity of alcohol consumption per month. Heavy, medium, and light intensity drinkers were defined as consuming more than 10 drinks, between 3-9 drinks and fewer than two drinks respectively on a typical day that they were drinking alcohol. One drink equated to eight grams of alcohol (roughly one third of a pint of beer).

Teenagers showed a preference for beer over wine or spirits, and those who tended to “binge drink” (have more than 10 drinks in a typical drinking day, with the aim of becoming drunk), had a relative increase of 4.7% in the stiffening of their arteries compared to “light” intensity drinkers. Participants in the “high” smoking and “high” drinking intensity group had a relative increase of 10.8% in the stiffening of their arteries compared to those who had never smoked and low alcohol consumers.

Dr Marietta Charakida, who carried out the research at UCL Institute of Cardiovascular Science, which is now at King's College London, said, "Injury to the blood vessels occurs very early in life as a result of smoking and drinking and the two together are even more damaging.

"Although studies have shown teenagers are smoking less in recent years, our findings indicated approximately one in five teenagers were smoking by the age of 17. In families where parents were smokers, teenagers were more likely to smoke.

"Governments and policy-makers need to devise and implement effective educational strategies, starting in childhood, to discourage children and teenagers from adopting smoking and bad drinking habits. They should also be told about the benefits of stopping these unhealthy behaviours."

She added: "The age at which participants started drinking alcohol was not associated with arterial health, suggesting that duration of exposure might not be that important at this young age. In addition, no beneficial effect of low alcohol consumption was found with regards to arterial health."

Commenting on the study, Professor Martin McKee, professor of European Public Health, London School of Hygiene & Tropical Medicine (LSHTM), said this is a well conducted study on an extremely well-defined cohort.

“This paper highlights the importance of examining the combined effects of exposure to agents that act through different mechanisms on the cardiovascular system as the adverse effects are likely to be greater than with either on its own. An obvious recent parallel is with research just published from the USA finding that, while both smoking and e-cigarette use appears to be associated with heart attacks, the risks associated with using them together were greater than either alone. Given that many risk factors cluster in deprived sections of the population, this reinforces the need for societal responses to reduce the likelihood that young people will engage in any form of harmful behaviour.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation, said it is widely known that smoking cigarettes and excessive drinking damage arteries which could lead to potentially deadly heart attacks or strokes.

“Our advice to everyone, including teenagers, is categorical - don't smoke and if you do try to give up as soon as possible. If you do drink, try to ensure that it’s not to excess and within the recommended guidelines.”

*Charakida M, Georgiopoulos G, Dangardt F, et al. Early vascular damage from smoking and alcohol in teenage years: the ALSPAC study. European Heart Journal, ehy524.

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470