NONPHARMACOLOGICAL MODIFICATION OF CARDIAC RISK-FACTORS - PART 3 - SMOKING CESSATION AND ALCOHOL-CONSUMPTION

Smoking cessation (SC) is probably the single most important risk fact or modification for both primary (1, 2) and secondary (3) prevention o f cardiovascular disease. Interventions to stop smoking are highly cos t effective (4). SC produces reductions in mortality and morbidity tha t generally outweigh any increase in risk due to weight gain, unless t he gain is so great that it is accompanied by adverse changes in blood pressure, lipid profile or glucose tolerance. There is clear evidence that SC improves the lipid profile, decreases thrombotic tendency, re duces vascular endothelial damage and improves insulin sensitivity. Ep idemiological studies consistently demonstrate a reduced risk of devel oping coronary heart disease (CHD) with moderate alcohol consumption ( showing protection at less than or equal to 2 drinks per day), but an increased risk at higher alcohol consumption levels. Potential mediato rs of these cardioprotective effects include an increase in high-densi ty cholesterol (HDL-C), decreased clotting propensity, enhanced insuli n sensitivity and glucose tolerance, and a possible lowering of blood pressure at low consumption levels in women. Alcohol consumption may n ot, however, compensate for the large increase in risk produced by smo king (5). Whereas moderate alcohol consumption slightly reduces the ri sk of death between the ages of 35 and 69 years, cigarette smoking app roximately doubles the risk (5).