Current but not past smoking increases the risk of cardiac events: insights from coronary computed tomographic angiography

Nakanishi R, Berman DS, Budoff MJ, Gransar H, Achenbach S, Al-Mallah M, Andreini D, Cademartiri F, Callister TQ, Chang HJ, Cheng VY, Chinnaiyan K, Chow BJW, Cury R, Delago A, Hadamitzky M, Hausleiter J, Feuchtner G, Kim YJ, Kaufmann PA, Leipsic J, Lin FY, Maffei E, Pontone G, Raff G, Shaw LJ, Villines TC, Dunning A, Min JK (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Book Volume: 36

Pages Range: 1031-40

Journal Issue: 17

DOI: 10.1093/eurheartj/ehv013

Abstract

We evaluated coronary artery disease (CAD) extent, severity, and major adverse cardiac events (MACEs) in never, past, and current smokers undergoing coronary CT angiography (CCTA).We evaluated 9456 patients (57.1 ± 12.3 years, 55.5% male) without known CAD (1588 current smokers; 2183 past smokers who quit >=3 months before CCTA; and 5685 never smokers). By risk-adjusted Cox proportional-hazards models, we related smoking status to MACE (all-cause death or non-fatal myocardial infarction). We further performed 1:1:1 propensity matching for 1000 in each group evaluate event risk among individuals with similar age, gender, CAD risk factors, and symptom presentation. During a mean follow-up of 2.8 ± 1.9 years, 297 MACE occurred. Compared with never smokers, current and past smokers had greater atherosclerotic burden including extent of plaque defined as segments with any plaque (2.1 ± 2.8 vs. 2.6 ± 3.2 vs. 3.1 ± 3.3, P < 0.0001) and prevalence of obstructive CAD [1-vessel disease (VD): 10.6% vs. 14.9% vs. 15.2%, P < 0.001; 2-VD: 4.4% vs. 6.1% vs. 6.2%, P = 0.001; 3-VD: 3.1% vs. 5.2% vs. 4.3%, P < 0.001]. Compared with never smokers, current smokers experienced higher MACE risk [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.4-2.6, P < 0.001], while past smokers did not (HR 1.2, 95% CI 0.8-1.6, P = 0.35). Among matched individuals, current smokers had higher MACE risk (HR 2.6, 95% CI 1.6-4.2, P < 0.001), while past smokers did not (HR 1.3, 95% CI 0.7-2.4, P = 0.39). Similar findings were observed for risk of all-cause death.Among patients without known CAD undergoing CCTA, current and past smokers had increased burden of atherosclerosis compared with never smokers; however, risk of MACE was heightened only in current smokers.

Authors with CRIS profile

Involved external institutions

Tennessee Heart & Vascular United States (USA) (US) Erasmus University Medical Center (MC) Netherlands (NL) New York Presbyterian Hospital United States (USA) (US) University of California Los Angeles (UCLA) United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Wayne State University (WSU) United States (USA) (US) Università degli studi di Milano Italy (IT) Casa di Cura Giovanni XXIII Italy (IT) Yonsei University Health System (YUHS) Korea, Republic of (KR) Oklahoma Heart Institute United States (USA) (US) Beaumont Health System United States (USA) (US) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Deutsches Herzzentrum München Germany (DE) Medizinische Universität Innsbruck Austria (AT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of British Columbia Canada (CA) Emory University United States (USA) (US) Walter Reed Army Medical Center (WRAMC) United States (USA) (US)

How to cite

APA:

Nakanishi, R., Berman, D.S., Budoff, M.J., Gransar, H., Achenbach, S., Al-Mallah, M.,... Min, J.K. (2015). Current but not past smoking increases the risk of cardiac events: insights from coronary computed tomographic angiography. European Heart Journal, 36(17), 1031-40. https://dx.doi.org/10.1093/eurheartj/ehv013

MLA:

Nakanishi, Rine, et al. "Current but not past smoking increases the risk of cardiac events: insights from coronary computed tomographic angiography." European Heart Journal 36.17 (2015): 1031-40.

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