How Smoking and Alcohol Impact Cardiovascular Health

Since the heart and circulatory system are vital components of human physiology, cardiovascular health is imperative to overall well-being. A healthy cardiovascular system means improved longevity and quality of life and less susceptibility to various diseases. However, despite widespread awareness of the importance of looking after your heart, certain lifestyle habits continue to pose significant threats: namely smoking and alcohol. 

In the United Kingdom, almost 13% of people aged 18 and over smoke. Though the figure may seem quite high, it is actually the lowest since records began in 2011. Worldwide, the statistics are alarming. According to the World Health Organization (WHO), there are 1.3 billion tobacco users worldwide. More than 8 million people die every year, which includes around 1.3 million non-smokers who have been exposed to second-hand smoke. 

As for alcohol, around 3 million people die each year due to the harmful use of alcohol. And around 6.2 litres of pure alcohol are drunk each year per person aged 15 and over. There are actually around 230 different diseases where alcohol plays a significant role, cardiovascular disease included.

As such, the ubiquity of these habits highlights the need for comprehensive education on their cardiovascular consequences. By understanding how smoking and alcohol exert their detrimental effects on the heart and circulatory system, individuals can make more informed decisions about their consumption and take proactive steps to improve their health.

Image source: Smoking – Our World in Data

The effects of smoking

The WHO claims that tobacco kills up to half of its users who don’t quit. That’s a scary statistic. However, smoking is a multifaceted habit. There is a myriad of detrimental effects on health, including on the cardiovascular system. However, just knowing what these are doesn’t make stopping easy.

The chemicals in tobacco

There are several toxic chemicals in cigarette smoke. These include:

Nicotine

This is the addictive component of tobacco. It is harmful because it acts as a vasoconstrictor. This means that it narrows blood vessels and increases blood pressure. When the vessels are constricted, the heart is forced to work harder to pump blood through the body. This places added strain on the cardiovascular system. Nicotine also stimulates the release of adrenaline. This then triggers an increase in heart rate, which further elevates blood pressure.

Carbon monoxide

This is a poisonous gas found in cigarette smoke. It binds to haemoglobin in red blood cells more readily than oxygen. This means that the blood’s oxygen-carrying capacity is reduced. As a result, vital organs, including the heart, receive insufficient oxygen. This exacerbates the risk of cardiovascular issues and complications.

Tar

This is a sticky residue that is produced by burning tobacco. It coats the lungs and airways and impairs their function. This causes an increase in the likelihood of respiratory diseases. Tar also contains toxic chemicals itself. These promote inflammation and damage the walls of the blood vessels. In turn, this paves the way for atherosclerosis, which is a condition characterised by plaque build-up within arteries.

The problems caused by smoking

Atherosclerosis is a hallmark of cardiovascular disease. It is a gradual accumulation of cholesterol and cellular debris inside the arteries. Smoking accelerates the process because it promotes inflammation and oxidative stress. Over time, the plaque obstructs the flow of blood to the heart in the coronary arteries. This leads to angina and could culminate in a heart attack (myocardial infarction). 

Smoking also heightens the risk of peripheral artery disease (PAD), which is narrowed arteries in the legs, arms and other parts of the body. This diminishes the blood flow to the extremities and causes leg pain, numbness and impaired wound healing. If it is left untreated, it increases the likelihood of serious complications, including limb amputation and gangrene.

Ischaemic stroke, a type of stroke caused by a clot or blockage in blood vessels that supply the brain, also has smoking as a potent risk factor. The detrimental effects of smoking on blood vessels along with the propensity of promoting blood clot formation means smokers have an increased risk of stroke. 

Notably, the harmful effects of smoking aren’t limited to individual smokers. Those exposed to second-hand smoke also suffer ill effects. Passive smoking can have profound impacts on cardiovascular health, and it increases the risk of coronary artery disease, stroke and other complications in non-smokers. In fact, second-hand smoke causes serious respiratory and cardiovascular diseases and kills around 1.3 million prematurely each year.

Image source: Smoking – Our World in Data

The effects of alcohol consumption

Alcohol consumption has varying effects on cardiovascular health depending on the quantity consumed. Moderate drinking is thought to have certain benefits. However, excessive alcohol intake can exert detrimental effects on heart function, blood pressure and cardiovascular well-being overall. 

Alcohol impacts heart function and blood pressure in a range of ways. In moderation, it dilates blood vessels. This leads to a temporary decrease in blood pressure. This vasodilatory effect is put down to the relaxation of smooth muscle cells within arterial walls. This facilitates blood flow and reduces cardiac workload. What’s more, moderate alcohol consumption has been associated with favourable lipid profiles—this means there are increased levels of high-density lipoprotein (HDL cholesterol – or ‘good’ cholesterol), which helps to remove low-density lipoprotein (LDL cholesterol – ‘bad’ cholesterol) from arteries. 

However, the majority of people are not drinking in moderation. Excessive consumption of alcohol negates the potential benefits. Instead, it elevates blood pressure, especially in those who are already predisposed to hypertension. 

When alcohol consumption is significant, it disrupts the balance of hormones and neurotransmitters that regulate blood pressure. This leads to sustained hypertension over time. When blood pressure is high, the heart has to work harder, which increases a person’s risk of cardiovascular problems like heart failure, stroke and heart attack.

When we’re talking about drinking in moderation, it’s important to understand what this means in real terms. Generally, this is defined as one drink a day for women and up to two for men. A standard alcoholic drink contains around 14g of pure alcohol. At this level per day, alcohol consumption is associated with a reduced risk of coronary artery disease, heart failure and ischaemic stroke. However, the precise mechanisms that create these benefits are subject to ongoing research. 

When speaking of excessive alcohol consumption, we generally mean chronic heavy drinking or binge drinking. This poses a significant risk to health, including deleterious consequences to cardiovascular health.

Consumed excessively, alcohol doesn’t just elevate blood pressure, it promotes the development of irregular heartbeats (arrhythmias) and weakening of the heart muscle (cardiomyopathy). It also causes alcoholic cardiomyopathy, which is heart muscle damage due to alcohol toxicity.

Despite any listed potential benefits of consuming alcohol moderately, we must recognise that this may not be a universal case. An individual’s response to alcohol will vary based on their age, sex, genetics and health status. The risks should also be weighed up against any perceived benefits. This includes the potential for addiction, liver disease and some cancers.

Preventive measures

Anyone worried about their smoking or alcohol intake can seek solutions to improve. Here are some ideas for quitting smoking:

• Plan to quit: Set a quit date for smoking and commit to it. This means you can plan carefully by seeking out support and nicotine replacement items if you choose to go down this route. Having a quit date will also mean you’ll not have cigarettes easily available.
• Know your triggers: When you’re planning to quit smoking, concentrate on what gives you the urge to smoke. Think about the situations, emotions and activities you do that encourage the behaviour. Common triggers are social situations (like a night out with alcohol), certain routines (like walking home from work) and stress. When you know your triggers, you can plan coping strategies for these situations.
• Seek support: Tell your friends, family, work colleagues and healthcare providers that you’re going to quit. Their support and encouragement will be important. Consider joining a support group to find like-minded people to support your journey.
• Use nicotine replacement products: Nicotine patches, gum, inhalers and lozenges help you in your journey to quitting because they alleviate withdrawal symptoms and cravings. Seek help from a healthcare professional to see which products will suit you best and make sure you follow the recommended usage guidelines.
• Practise ways to manage stress: Develop healthy coping strategies to manage stress and anxiety so that you don’t resort to smoking. Try relaxation techniques like meditation, deep breathing or a physical activity to alleviate tension.
• Replace smoking with a healthy habit: If you can find an alternative activity to occupy your time and distract you, you’re more likely to succeed. This could be a new hobby (especially if it engages your hands), exercise or other activities that bring you joy.

Quitting alcohol also requires a plan and how you go about it depends on how much you’re currently consuming. Cold turkey can be dangerous for some heavy drinkers. Here are some tips to help:

• Set yourself limits: Some people choose to establish limits for their alcohol consumption and, provided you can stick to them, this works well. Monitor your intake so you don’t exceed the recommended guidelines.
• Practise moderation: Pace yourself when you drink alcohol and avoid binge drinking. Drink slowly and try having a soft drink in between each alcoholic drink. Go for singles instead of doubles too.
• Know your triggers: Identify the times when you choose to drink alcohol in excess. This could be boredom, social pressure or stress. Develop strategies to cope with the triggers so that you don’t rely on alcohol. Seek support from friends and engage in stress-relieving activities instead.
• Eat well and stay hydrated: Be sure to drink plenty of water and consume food when you drink alcohol. This helps to slow its absorption and minimise its effects on the body. Choose nutritious meals and snacks to mitigate the negative impact of alcohol on cardiovascular health.
• Plan ahead: Before you drink alcohol, consider how you’ll get home and avoid driving. If you’re on a mission to reduce your alcohol consumption, offer to be the designated driver.
• Be careful if you take medication: Consult with your healthcare provider about alcohol and medication interactions. Some shouldn’t be taken with alcohol as they can cause complications or adverse effects.
• Know when you need to seek help: If you struggle to moderate your drinking or experience negative consequences as a result, you may need to seek professional help. There are lots of resources and support available for alcohol addiction nowadays and your GP will be the first port of call to access such services.

By implementing these practical tips and strategies, individuals can take proactive steps to reduce or quit smoking and practise responsible alcohol consumption to aim for optimal cardiovascular health.

Check how much you know

Which of the following chemicals present in cigarette smoke contributes to the development of atherosclerosis?

• Nicotine
• Carbon monoxide
• Tar
• All of the above

What is the recommended daily limit for moderate alcohol consumption for men and women, respectively?

• Up to two drinks for men, up to one drink for women
• Up to three drinks for men, up to two drinks for women
• Up to one drink for men, up to two drinks for women
• Up to four drinks for men, up to three drinks for women

True or False: Smoking accelerates the process of atherosclerosis by promoting inflammation and damaging blood vessel walls.

• True
• False

True or False: Excessive alcohol consumption can lead to elevated blood pressure, which increases the risk of cardiovascular complications such as heart attack and stroke.

• True
• False

Answers:

• d) All of the above
• a) Up to two drinks for men, up to one drink for women
• a) True
• a) True

There’s a clear and intricate relationship between smoking, alcohol consumption and cardiovascular health. Here are the key takeaways:

Final thoughts on how smoking and alcohol impact cardiovascular health

• Smoking introduces harmful chemicals into the body, accelerating the progression of cardiovascular diseases such as atherosclerosis, coronary artery disease, stroke and peripheral artery disease. Second-hand smoke exposure also increases these risks.
• While moderate alcohol consumption may offer certain cardiovascular benefits, excessive drinking can lead to elevated blood pressure, arrhythmias and cardiomyopathy. It is crucial to distinguish between responsible alcohol consumption and harmful drinking patterns to minimise the risk of cardiovascular complications.
• Making informed lifestyle choices is paramount in safeguarding heart health. By understanding the detrimental effects of smoking and excessive alcohol consumption, individuals can seek to reduce their risk of cardiovascular diseases.