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

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

doi:10.1093/eurheartj/ehv013

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

Eur Heart J. 2015 May 1;36(17):1031-40. doi: 10.1093/eurheartj/ehv013. Epub 2015 Feb 8.

Authors

Rine Nakanishi¹, Daniel S Berman², Matthew J Budoff¹, Heidi Gransar², Stephan Achenbach³, Mouaz Al-Mallah⁴, Daniele Andreini⁵, Filippo Cademartiri⁶, Tracy Q Callister⁷, Hyuk-Jae Chang⁸, Victor Y Cheng⁹, Kavitha Chinnaiyan¹⁰, Benjamin J W Chow¹¹, Ricardo Cury¹², Augustin Delago¹³, Martin Hadamitzky¹⁴, Jörg Hausleiter¹⁴, Gudrun Feuchtner¹⁵, Yong-Jin Kim¹⁶, Philipp A Kaufmann¹⁷, Jonathon Leipsic¹⁸, Fay Y Lin¹⁹, Erica Maffei⁶, Gianluca Pontone⁵, Gilbert Raff¹⁰, Leslee J Shaw²⁰, Todd C Villines²¹, Allison Dunning²², James K Min²³

Affiliations

¹ Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA.
² Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ Department of Medicine, University of Erlangen, Erlangen, Germany.
⁴ Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
⁵ Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
⁶ Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁷ Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
⁸ Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea.
⁹ Oklahoma Heart Institute, Tulsa, OK, USA.
¹⁰ William Beaumont Hospital, Royal Oaks, MI, USA.
¹¹ Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada.
¹² Baptist Cardiac and Vascular Institute, Miami, FL, USA.
¹³ Capitol Cardiology Associates, Albany, NY, USA.
¹⁴ Division of Cardiology, DeutschesHerzzentrumMünchen, Munich, Germany.
¹⁵ Department of Radiology, Medical University of Innsbruck, Innsbuck, Austria.
¹⁶ Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea.
¹⁷ Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
¹⁸ Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, USA.
¹⁹ Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
²⁰ Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
²¹ Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA.
²² Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
²³ Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA jkm2001@med.cornell.edu runone123@gmail.com.

Abstract

Aims: 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).

Methods and results: 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.

Conclusion: 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.

Keywords: Coronary atherosclerosis; Coronary computed tomographic angiography; Major adverse cardiovascular risk; Smoking risk.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography / methods
Coronary Artery Disease / diagnostic imaging
Coronary Artery Disease / etiology*
Coronary Artery Disease / mortality
Epidemiologic Methods
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnostic imaging
Myocardial Infarction / etiology
Myocardial Infarction / mortality
Plaque, Atherosclerotic / diagnostic imaging
Plaque, Atherosclerotic / etiology
Prognosis
Smoking / adverse effects*
Tomography, X-Ray Computed / methods

Abstract

Publication types

MeSH terms

Grants and funding