Tobacco and Public Health - TCSC Indonesia

Heavy drinking is known to cause gastritis of the stomach, a possible explanation why
heavy drinking raises the risk of gastric cancer.
Non-malignant disease
ALBERT B. LOWENFELS AND PATRICK MAISONNEUVE
Cardiovascular system
Consumption of alcohol and tobacco has important implications for the heart and for
the entire vascular system. There is strong evidence that high levels of exposure to
either of these agents damages the heart, leading to both increased morbidity and
mortality. The main impact of tobacco relates to the increased risk of atherosclerosis,
causing narrowing of coronary arteries and, eventually to myocardial infarction. Large
amounts of alcohol are cardiotoxic, causing cardiomyopathy, and in some heavy
drinkers, fatal cardiac arrhythmias.
The interaction of these agents has been studied in healthy volunteers. Ethanol and
nicotine increased heart rate, and also increased the product of heart rate times blood
pressure. The combination of exposure to both drugs could contribute to serious
arrhythmias and sudden death, especially in persons with pre-existing coronary heart
disease (Benowitz et al. 1986).
In patients with pre-existing heart disease, both alcohol and tobacco are independent
risk factors for disease progression. Evangelista and co-workers (Evangelista et al.
2000) conducted a longitudinal study of 753 patients previously hospitalized with
heart disease. In a multivariate analysis current smoking (odds ratio 1.8, 95% confidence
interval 1.2–2.8) and current drinking (odds ratio 5.8, 95% confidence interval
3.8–9.1) were independent predictors of readmission for heart disease.
The deleterious effects of tobacco on the heart are dose-related, with no demonstrable
‘safe’ level of exposure to tobacco. But for alcohol, there are several longitudinal studies
suggesting that persons consuming low levels of alcohol—generally about 1 or perhaps
two drinks per day, have a lower risk of cardiac disease than abstainers or than persons
consuming larger quantities of alcohol do (Fuchs et al. 1995; Thun et al. 1997). The
overall impact on large populations is questionable and if there is a benefit from light
drinking, it is likely to affect males more than females, and older persons rather than
younger persons.
Pancreatitis
The pancreas, unlike the mouth, the larynx, the esophagus or the stomach, does not
come into direct contact with ingested alcohol. Alcohol reaches the pancreas via the
blood stream, where it stimulates pancreatic secretion, either directly or via activation
of the secretin mechanism. Moderate consumption of alcohol does not usually cause
pancreatic injury, but heavy drinking is a major cause of both acute and chronic
pancreatitis.
There is evidence from many sources that the combination of heavy drinking and
smoking is especially injurious to the pancreas. Individuals who drink heavily tend to
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