Association of tobacco use and cessation with coronary atherosclerosis

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP CHEEZUM, Michael K.
KIM, Alexander
NISSEN, Alexander
THOMAS, Dustin M.
Binh Nguyen
GLYNN, Robert J.
SHAH, Nishant R.
VILLINES, Todd C. 2017
dc.identifier.citation ATHEROSCLEROSIS, v.257, p.201-207, 2017
dc.identifier.issn 0021-9150
dc.description.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 [1.04e2.46], 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.
dc.description.sponsorship · Harvard Catalyst \ The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) [UL1 TR001102]
· Harvard University
· Harvard Catalyst \ The Harvard Clinical and Translational Science Center (National Center for Research Resources)
dc.language.iso eng
dc.relation.ispartof Atherosclerosis
dc.rights restrictedAccess
dc.subject Atherosclerosis; Coronary computed tomographic angiography; Smoking; Tobacco; Coronary artery disease
dc.subject.other computed tomographic angiography; prognostic value; cardiovascular-disease; scct guidelines; ct angiography; risk-factors; smoking; diagnosis; micrornas; mortality
dc.title Association of tobacco use and cessation with coronary atherosclerosis
dc.type article
dc.rights.holder Copyright ELSEVIER IRELAND LTD
dc.identifier.doi 10.1016/j.atherosclerosis.2016.11.016
dc.identifier.pmid 27993385
dc.type.category original article
dc.type.version publishedVersion BITTENCOURT, Marcio S.:HU:SCPACEX-62 · CHEEZUM, Michael K.:Walter Reed Natl Mil Med Ctr, Cardiol Serv, Dept Med, 8901 Rockville Pike, Bethesda, MD 20889 USA
· KIM, Alexander:Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
· KASSOP, David:Womack Army Med Ctr, Dept Med, Cardiol Serv, Ft Bragg, NC USA
· NISSEN, Alexander:Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
· THOMAS, Dustin M.:San Antonio Mil Med Ctr, Cardiol Serv, Dept Med, San Antonio, TX USA
· Binh Nguyen:Walter Reed Natl Mil Med Ctr, Dept Radiol, Bethesda, MD USA
· GLYNN, Robert J.:Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA
· VILLINES, Todd C.:Walter Reed Natl Mil Med Ctr, Cardiol Serv, Dept Med, 8901 Rockville Pike, Bethesda, MD 20889 USA 2-s2.0-85008195296 WOS:000397405600027 CLARE IRELAND
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dc.description.index MEDLINE
dc.identifier.eissn 1879-1484
hcfmusp.citation.scopus 5
hcfmusp.citation.wos 3 Brasil Estados Unidos

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