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Comparative Study
. 2017 Feb:257:201-207.
doi: 10.1016/j.atherosclerosis.2016.11.016. Epub 2016 Nov 16.

Association of tobacco use and cessation with coronary atherosclerosis

Michael K Cheezum  1 , Alexander Kim  2 , Marcio S Bittencourt  3 , David Kassop  4 , Alexander Nissen  2 , Dustin M Thomas  5 , Binh Nguyen  6 , Robert J Glynn  7 , Nishant R Shah  8 , Todd C Villines  9
Affiliations
Comparative Study

Association of tobacco use and cessation with coronary atherosclerosis

Michael K Cheezum et al. Atherosclerosis. 2017 Feb.

Abstract

Background and aims: The impact of tobacco use and cessation on atherogenesis remains unclear. We aimed to study the association of tobacco use and prior cessation with the presence, extent and severity of atherosclerosis on coronary computed tomographic angiography (CTA).

Methods: We examined 1798 consecutive symptomatic patients without known coronary artery disease (CAD) referred for CTA, stratified by smoking status (never, current [within 30 days], or former [>30 days before CTA]). Plaque severity (none, <50%, ≥50% stenosis), composition (non-calcified [NCP], partially calcified [PCP], or calcified plaque [CP]), and segment involvement score (SIS) were visually graded. Multivariate analysis was performed, adjusting for CAD risk factors and cholesterol lowering medication use.

Results: The median age of patients was 50 years [IQR:42-58] (61% male), with 74% never smokers, 12% current smokers, and 14% former smokers (median quit duration = 12 years [IQR:3-26]). Smoking exposure in former versus current smokers was 11 [IQR:5-25] and 10 [IQR:2-20] pack-years, respectively (p = 0.01). Compared to never smokers, current smokers demonstrated an increased odds ratio of all plaque types (adjusted OR: any NCP = 1.55 [95% CI 1.04-2.32], p = 0.03; any PCP = 1.61 [1.10-2.37], p = 0.02; any CP = 1.93 [1.32-2.81], p = 0.001), non-obstructive CAD (aOR = 1.47 [1.04, 2.07], p = 0.03), obstructive CAD (aOR = 1.81 [1.01-3.24], p = 0.047), and SIS > 4 (aOR = 1.60 [1.04-2.46], p = 0.03). Compared to current smoking, prior smoking cessation (≥12 years) was associated with a decreased odds ratio of any NCP (aOR = 0.42 [0.19-0.90], p = 0.03), CP (aOR = 0.43 [0.22-0.84], p = 0.02), and obstructive CAD (aOR = 0.40, [0.15-0.98], p = 0.048).

Conclusions: Current smoking is independently associated with the presence and extent of coronary plaque, and a higher risk of non-obstructive and obstructive CAD compared to never smoking. Prior smoking cessation correlated with improvements in CTA-identified plaque measures.

Keywords: Atherosclerosis; Coronary artery disease; Coronary computed tomographic angiography; Smoking; Tobacco.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest and no relationship with industry related to this work. The opinions herein and assertions contained are the authors’ alone, and do not constitute endorsement by the Department of the Army, Department of Defense or the United States Government. The content is solely the responsibility of the authors and does not represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.

Figures

Fig. 1
Fig. 1. Rate of obstructive CAD stratified by smoking status and age tertile
Demonstrates association of current smoking with the highest rate of obstructive CAD as a percentage of patients across age tertiles.
Fig. 2
Fig. 2. Association of smoking history with CAD measures
Adjusted odds ratio of CAD measures by comparison to never smokers (n=1339), among patients with complete pack-year information and < 12 pack-year (n=179) or ≥ 12 pack-year smoking history (n=149). Demonstrates that patients with ≥ 12 pack-year exposure had a higher likelihood of all CAD measures versus never smoking. Adjusted for age, gender, BMI, diabetes, family history of early CAD, hypertension, hyperlipidemia, and use of a statin or non-statin cholesterol medication.
Fig. 3
Fig. 3. Association of prior smoking cessation with CAD measures
Adjusted odds ratio of plaque type, severity and extent by comparison to current smokers (n=216), among patients who quit smoking within 12 years prior to CTA (n=90) and ≥ 12 years prior to CTA (n=94). Note that patients who quit ≥ 12 years previously had a lower likelihood of non-calcified plaque, calcified plaque and a lower likelihood of obstructive CAD. Analyses performed for patients with complete smoking cessation information, adjusted for age, gender, BMI, diabetes, family history of early CAD, hypertension, hyperlipidemia, and statin or non-statin cholesterol medications.
See this image and copyright information in PMC

Comment in

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