The risk of developing age-related visible signs, such as arcus cornea and earlobe crease, was higher in smokers and heavy drinkers in a prospective study from Denmark.

A total of 11, 613 individuals enrolled in the Copenhagen City Heart Study, a prospective cardiovascular study of the Danish population set up in 1976, were studied. Self-reported information on alcohol intake, smoking habits and other lifestyle factors were recorded on questionnaires. Participants were examined for the visible age-related signs of arcus cornea, xanthelasmata, and earlobe crease in 1976, 1981-83, and 1991-94 and for male pattern baldness in 1976 and 1991-94. Examination was carried out by trained nurses or laboratory technicians who did not know the participant’s risk or disease profile.

The average age of the participants was 51, ranging from 21 to 86 for women, and 21 to 93 for men.

Median alcohol consumption was 2.6 drinks/week for women and 11.4 for men. Just over half the women (57%) and around two-thirds of the men (67%) were current smokers.

The risk of developing arcus cornea, earlobe crease and xanthelasmata was increased in smokers. For alcohol consumption, a high intake was associated with the risk of developing arcus cornea and earlobe crease, but not xanthelasmata, see table 1.

Neither heavy drinking (> 21 drinks/ week) nor smoking were associated with male pattern baldness. 

Furthermore, light to moderate drinking was not associated with biological ageing and there was no difference in the prevalence of the signs of ageing between light to moderate drinkers and non-drinkers.

‘Visible age-related signs have been found to predict cardiovascular disease and death, indicating that biological age to some extent can be observed visually,’ the study authors state.

‘We found that a high alcohol intake and smoking were associated with increased  occurrence of visible age-related signs and thus looking older than one’s actual age. This may reflect that heavy drinking and smoking increases general ageing of the body,’ they conclude.

However, this was an observational study so it cannot prove causality and the data on smoking and drinking relied on patient recall which of course is subject to bias. Finally, the study did not address underlying stress which can be associated not only with cardiovascular risk but also smoking and heavier alcohol consumption.

Dr Peter Savill

Schou AL, Mølbak M, Schnor P et al. Alcohol consumption, smoking and development of visible age-related signs: a prospective cohort study. J Epidemiol Community Health 2017;71:1177-84