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. 2021 Apr 6;10(7):e017320.
doi: 10.1161/JAHA.120.017320. Epub 2021 Mar 23.

Cigarette Smoking, Incident Coronary Heart Disease, and Coronary Artery Calcification in Black Adults: The Jackson Heart Study

Adebamike A Oshunbade  1 , Wondwosen Kassahun-Yimer  2 , Karen A Valle  2 , Arsalan Hamid  1 , Rodney K Kipchumba  3 , Daisuke Kamimura  1   4 , Donald Clark 3rd  1 , Wendy B White  5 , Andrew P DeFilippis  6 , Michael J Blaha  7 , Emelia J Benjamin  8   9 , Emily C O'Brien  10 , Robert J Mentz  10 , Carlos J Rodriguez  11 , Ervin R Fox  1 , Javed Butler  1 , Rachel J Keith  12 , Aruni Bhatnagar  12 , Rose Marie Robertson  13   14 , Adolfo Correa  1 , Michael E Hall  1
Affiliations

Cigarette Smoking, Incident Coronary Heart Disease, and Coronary Artery Calcification in Black Adults: The Jackson Heart Study

Adebamike A Oshunbade et al. J Am Heart Assoc. .

Abstract

Background Although Black adults are more likely to die from coronary heart disease (CHD) compared with White adults, few studies have examined the relationship between cigarette smoking and CHD risk among Black adults. We evaluated the relationship between cigarette smoking, incident CHD, and coronary artery calcification in the JHS (Jackson Heart Study). Methods and Results We classified JHS participants without a history of CHD (n=4432) by self-reported baseline smoking status into current, former (smoked at least 400 cigarettes/life) or never smokers at baseline (2000-2004). We further classified current smokers by smoking intensity (number of cigarettes smoked per day [1-19 or ≥20]) and followed for incident CHD (through 2016). Hazard ratios (HR) for incident CHD for each smoking group compared with never smokers were estimated with adjusted Cox proportional hazard regression models. At baseline, there were 548 (12.4%) current, 782 (17.6%) former, and 3102 (70%) never smokers. During follow-up (median, 13.8 years), 254 participants developed CHD. After risk factor adjustment, CHD risk was significantly higher in current smokers compared with never smokers (HR, 2.11; 95% CI, 1.39-3.18); the difference between former smokers and never smokers (HR, 1.37; 95% CI, 1.0-1.90) did not achieve statistical significance. Among current smokers, we did not observe a dose-response effect for CHD risk. Additionally, in multivariable logistic regression models with a subset of our analytic cohort, current smokers had greater odds of coronary artery calcification score >0 compared with never smokers (odds ratio, 2.63; 95% CI, 1.88-3.68). Conclusions In a large prospective cohort of Black adults, current smoking was associated with a >2-fold increased risk of CHD over a median follow-up of greater than a decade.

Keywords: Black adults; Jackson Heart Study; cigarette smoking; coronary artery calcification; coronary heart disease.

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Conflict of interest statement

Dr Benjamin serves as an uncompensated member for the MyHeartLab Steering Committee. The MyHeartLab Study is a principal investigator–initiated study from the University of California San Francisco: principal investigator, Jeffrey Olgin, MD, through a research grant to University of California San Francisco from Samsung. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Flow diagram for determination of final study population.
**171 participants were administratively censored, and 657 died during the follow‐up period in JHS. CHD indicates coronary heart disease; and JHS, Jackson Heart Study.
Figure 2
Figure 2. Kaplan‐Meier survival curves of the study participants by smoking status.
CHD indicates coronary heart disease.
Figure 3
Figure 3. Distribution of log‐transformed CAC scores at visit 2 among JHS participants by smoking status.
CAC indicates coronary artery calcification; CHD, coronary heart disease; and JHS, Jackson Heart Study.
See this image and copyright information in PMC

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