IJCS | Volume 32, Nº2, May/June 2019

266 Albuquerque et al. Association smoking and alcohol consumption AMI Int J Cardiovasc Sci. 2019;32(3)261-268 Original Article the correlation between the number of pack-year and the TFC, there was no association of smoking with the mean SYNTAX score, LVEF and TFC. The results showed a greater number of alcoholic patients among non-hypertensive than among hypertensive ones (40.7%versus 24.4%). Different studies in the literature show that, among hypertensive patients, the majority consumes alcoholic beverages, 27,28 which diverges from these results. It is known that excessive alcohol consumption is associated with hypertension 29 and that light-to-moderate alcohol consumption, on the other hand, does not have a substantial impact on blood pressure. 30 Therefore, we could explain this finding by admitting the possibility that the patients in this study consume less alcohol, which, perhaps, would not be associated with hypertension in the same way as excessive consumption. The results also show a higher prevalence of non- diabetic patients (36.4%) among alcoholic patients than non-diabetic ones (12.0%), which may indicate that alcohol has a protective effect on diabetes. Skliros et al also showed that, among patients with light consumption of alcohol, 85.2% had no DM. 27 The literature shows that light-to-moderate alcohol consumption is associatedwith a reduced risk of DMand it seems to play a protective role for its development, 31,32 which might justify this result. We also found that most patients who smoked had no diabetes (38.1%). On the other hand, studies show that there is an association of smoking with increased DM risk. 33,34 A possible explanation for this result would be the fact that diabetic patients, already aware of the severity and comorbities associated with their disease, choose to stop smoking. This result may also be attributed to chance. There was also an association between gender and alcohol consumption, in which 59.7% of men and 85.4% of women had no drinking habits (p < 0.001). Such difference between sexes was also noted in the Greek study by Skilros et al., 27 in which 40.2% of men and 59.8% of women did not consume alcoholic beverages. 27 In spite of the careful design and performance of this study, it is worth pointing out that there are some limitations to the analysis and interpretation of the results: it has a cross-sectional design within a cohort that follows patients admitted to emergency departments with a first episode of AMI, and, thus, cannot prove cause/effect. In addition, it has a small sample size, which can be influenced by other variables that were not assessed. Furthermore, the SYNTAX scores found were low, and, therefore, they cannot be extrapolated to a population with higher SYNTAX scores. Certain differences and correlations found can be viewed as the result of mere chance. However, these biases do not invalidate the results found, because it is a study with valuable national data and which raises hypothesis for the development of potential clinical trials and cohorts for the assessment of specific variables, such as smoking and alcohol in AMI. It is worth to highlight that efforts to avoid that patients start smoking or to promote tobacco cessation should bemassively employed, and the smoker’s paradox should not be mistakenly interpreted and used to encourage cigarette consumption. Moreover, it is necessary to search for a better understanding of the effects of alcohol consumption on the pathogenesis of hypertension and diabetes on a greater number of studies, before encouraging its consumption. Conclusion There was a negative correlation between the number of cigarettes consumed per day and the number of pack-year with the TIMI frame count. There was no correlation between alcohol consumption – be it wine or other types – with the SYNTAX score, the LVEF and the TIMI frame count. The study found an association between alcohol consumption and the prevalence of hypertension, diabetes and patients’ sexes. In addition, we found an association of diabetes with smoking. There was no association of the severity and complexity of coronary injuries and ventricular function with smoking and alcohol consumption. Author contributions Conception and design of the research: Albuquerque LG, Moreira DM. Acquisition of data: Albuquerque LG, Silva RL, Fattah T. Analysis and interpretation of the data: Albuquerque LG, Moreira DM. Statistical analysis: Albuquerque LG, Moreira DM. Obtaining financing: Albuquerque LG, Moreira DM. Writing of the manuscript: Albuquerque LG. Critical revision of the manuscript for intellectual content: Albuquerque LG, Moreira DM. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported.