Association between smoking and the risk of heavy drinking among young women: a prospective study.

AIM: To address the association between smoking habits and the risk of later heavy drinking among young women. METHODS: Repeated assessments of alcohol and smoking habits were obtained in 1991-93 and 1999-2000 in a Danish representative cohort in Copenhagen. A total of 6369 non- to moderate-drinking Danish women, aged 20-29 years at baseline, attended a follow-up examination and were included in the study. The risk of becoming a heavy drinker (more than 14 drinks per week) 8 years after enrolment was analyzed by means of logistic regression. RESULTS: A total of 177 women became heavy drinkers during follow-up. Daily smoking at baseline was associated with an increased risk of becoming a heavy drinker 8 years later. Relative to nonsmokers, the adjusted odds ratios (OR) for becoming a heavy drinker associated with smoking 1-14, 15-24, or more than 24 cigarettes per day were 1.6 (95% confidence intervals (CI) 1.1-2.4), 1.7 (CI 1.1-2.6), and 2.3 (CI 0.9-5.9), respectively. Age at sexual debut modified the effect of smoking, and women with a debut before the age of 15 years had an adjusted OR of 2.9 (CI 1.1-3.9) compared to never-smokers while there seemed to be no effect among women with a sexual debut after the age of 18. In addition, relative to nondrinkers, all of the moderate (1-5 units per week), medium (6-10 units), and large (10-14 units) alcohol consumption at baseline were associated independently with becoming a heavy drinker 8 years later. CONCLUSIONS: This study suggests that smoking is an important predictor of later heavy drinking among young women and that this relatively elevated risk is most pronounced among women with an early sexual debut.

Perceived stress and risk of ischemic heart disease: causation or bias?

BACKGROUND: It is unclear whether the commonly recognized link between stress and cardiovascular disease is causal or the result of reporting bias. The objective of this study was to address the association between perceived stress and first incidence of ischemic heart disease and to evaluate the suggested reporting bias by addressing subdiagnoses of ischemic heart disease separately. METHODS: The 11,839 men and women who participated in the Copenhagen City Heart Study were at baseline (1981-1983) asked about their stress level. The participants were followed in nationwide registries until the year 2000, and fewer than 0.1% were lost to follow-up. During follow-up, 2316 individuals were diagnosed with ischemic heart disease. RESULTS: High levels of stress were associated with slightly higher risk of incident ischemic heart disease in both women (hazard ratio = 1.23; 95% confidence interval = 1.01-1.51) and men (1.25; 1.00-1.56). When subdiagnoses of ischemic heart disease were analyzed separately, high stress was associated with markedly higher incidence of angina pectoris for women (1.83; 1.15-2.91) and for men (2.14; 1.32-3.47). There was no association with myocardial infarction for women (0.80; 0.56-1.15) or for men (1.09; 0.79-1.52). All associations attenuated with prolonged follow-up. CONCLUSIONS: It remains uncertain whether perceived stress affects subdiagnoses of ischemic heart disease differently or whether the strong association with angina pectoris was spuriously created by a tendency for stressed individuals to report more cardiovascular symptoms. Future studies on this issue should address subdiagnoses of ischemic heart disease separately and should carefully consider the impact of reporting bias and prolonged follow-up.