Cigarette Smoking and Progression of Atherosclerosis: The Atherosclerosis Risk in Communities (ARIC) Study

CONTEXT.— Cigarette smoking is a powerful risk factor for incident heart disease and stroke, but the relationship of active and passive smoking with the progression of atherosclerosis has not been described. OBJECTIVE.— To examine the impact of active smoking and exposure to environmental tobacco sm...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 1998-01, Vol.279 (2), p.119-124
Main Authors: Howard, George, Wagenknecht, Lynne E, Burke, Gregory L, Diez-Roux, Ana, Evans, Gregory W, McGovern, Paul, Nieto, F. Javier, Tell, Grethe S, for the ARIC Investigators
Format: Article
Language:English
Subjects:
Arteriosclerosis - diagnostic imaging
Arteriosclerosis - epidemiology
Arteriosclerosis - pathology
Arteriosclerosis - physiopathology
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular disease
Carotid Arteries - diagnostic imaging
Carotid Arteries - pathology
Cohort Studies
Coronary vessels
Disease Progression
Female
Humans
Life Style
Linear Models
Longitudinal Studies
Male
Medical disorders
Medical research
Medical sciences
Middle Aged
Risk Factors
Smoking - adverse effects
Tobacco smoke
Tobacco Smoke Pollution - adverse effects
Tunica Intima - pathology
Ultrasonography
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Summary:CONTEXT.— Cigarette smoking is a powerful risk factor for incident heart disease and stroke, but the relationship of active and passive smoking with the progression of atherosclerosis has not been described. OBJECTIVE.— To examine the impact of active smoking and exposure to environmental tobacco smoke (ETS) on the progression of atherosclerosis. DESIGN.— A longitudinal assessment of the relationship between smoking exposure evaluated at the initial visit and the 3-year change in atherosclerosis. SETTING.— A population-based cohort of middle-aged adults from 4 communities in the United States. PARTICIPANTS.— A total of 10914 participants from the Atherosclerosis Risk in Communities (ARIC) study enrolled between 1987 and 1989. MAIN OUTCOME MEASURE.— Change in atherosclerosis from baseline to the 3-year follow-up as indexed by intimal-medial thickness of the carotid artery assessed by ultrasound and adjusted for demographic characteristics, cardiovascular risk factors, and lifestyle variables. RESULTS.— Exposure to cigarette smoke was associated with progression of atherosclerosis. Relative to never smokers and after adjustment for demographic characteristics, cardiovascular risk factors, and lifestyle variables, current cigarette smoking was associated with a 50% increase in the progression of atherosclerosis (mean progression rate over 3 years, 43.0 µm for current and 28.7 µm for never smokers, regardless of ETS exposure), and past smoking was associated with a 25% increase (mean progression rate over 3 years, 35.8 µm for past smokers and 28.7 µm for never smokers). Relative to those not exposed to ETS, exposure to ETS was associated with a 20% increase (35.2 µm for those exposed to ETS vs 29.3 µm for those not exposed). The impact of smoking on atherosclerosis progression was greater for subjects with diabetes and hypertension. Although more pack-years of exposure was independently associated with faster progression (P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.279.2.119