Michael K Cheezum1, Alexander Kim2, Marcio S Bittencourt3, David Kassop4, Alexander Nissen2, Dustin M Thomas5, Binh Nguyen6, Robert J Glynn7, Nishant R Shah8, Todd C Villines9. 1. Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD, USA. Electronic address: michael.k.cheezum.mil@mail.mil. 2. Uniformed Services University of Health Sciences, Bethesda, MD, USA. 3. Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil. 4. Department of Medicine (Cardiology Service), Womack Army Medical Center, Ft. Bragg, NC, USA. 5. Department of Medicine (Cardiology Service), San Antonio Military Medical Center, San Antonio, TX, USA. 6. Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA. 7. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 8. Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, RI, USA. 9. Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD, USA.
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. Published by Elsevier B.V.
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. Published by Elsevier B.V.
Authors: Edward A Hulten; Salvatore Carbonaro; Sara P Petrillo; Joshua D Mitchell; Todd C Villines Journal: J Am Coll Cardiol Date: 2010-12-08 Impact factor: 24.094
Authors: Rine Nakanishi; Daniel S Berman; Matthew J Budoff; Heidi Gransar; Stephan Achenbach; Mouaz Al-Mallah; Daniele Andreini; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Victor Y Cheng; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo Cury; Augustin Delago; Martin Hadamitzky; Jörg Hausleiter; Gudrun Feuchtner; Yong-Jin Kim; Philipp A Kaufmann; Jonathon Leipsic; Fay Y Lin; Erica Maffei; Gianluca Pontone; Gilbert Raff; Leslee J Shaw; Todd C Villines; Allison Dunning; James K Min Journal: Eur Heart J Date: 2015-02-08 Impact factor: 29.983
Authors: R T van Domburg; K Meeter; D F van Berkel; R F Veldkamp; L A van Herwerden; A J Bogers Journal: J Am Coll Cardiol Date: 2000-09 Impact factor: 24.094
Authors: James K Min; Leslee J Shaw; Richard B Devereux; Peter M Okin; Jonathan W Weinsaft; Donald J Russo; Nicholas J Lippolis; Daniel S Berman; Tracy Q Callister Journal: J Am Coll Cardiol Date: 2007-09-04 Impact factor: 24.094
Authors: Earl S Ford; Umed A Ajani; Janet B Croft; Julia A Critchley; Darwin R Labarthe; Thomas E Kottke; Wayne H Giles; Simon Capewell Journal: N Engl J Med Date: 2007-06-07 Impact factor: 91.245
Authors: Fariborz Mobarrez; Lukasz Antoniewicz; Jenny A Bosson; Jeanette Kuhl; David S Pisetsky; Magnus Lundbäck Journal: PLoS One Date: 2014-02-28 Impact factor: 3.240
Authors: Ning Ding; Yingying Sang; Jingsha Chen; Shoshana H Ballew; Corey A Kalbaugh; Maya J Salameh; Michael J Blaha; Matthew Allison; Gerardo Heiss; Elizabeth Selvin; Josef Coresh; Kunihiro Matsushita Journal: J Am Coll Cardiol Date: 2019-07-30 Impact factor: 24.094
Authors: Cullen Soares; Amjad Samara; Matthew F Yuyun; Justin B Echouffo-Tcheugui; Ahmad Masri; Ahmad Samara; Alan R Morrison; Nina Lin; Wen-Chih Wu; Sebhat Erqou Journal: J Am Heart Assoc Date: 2021-09-29 Impact factor: 5.501