title: Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States.
abstract: BACKGROUND
  Few studies have examined the relationship between cigarette smoking and novel risk factors for cardiovascular disease in a general population or have included a biochemical marker of current smoking.
  
  
  OBJECTIVE
  To examine the relationship between cigarette smoking and serum C-reactive protein, fibrinogen, and homocysteine levels.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The U.S. general population.
  
  
  METHODS
  4187 current smokers, 4791 former smokers, and 8375 never-smokers 18 years of age or older who participated in the Third National Health and Nutrition Examination Survey conducted between 1988 and 1994.
  
  
  METHODS
  Serum C-reactive protein levels were categorized as detectable (2.2 to 9.9 mg/L) or clinically elevated (> or =10 mg/L), and fibrinogen and homocysteine levels were defined as elevated if in the 85th percentile or greater (11.1 micromol/L and 12.7 mmol/L, respectively).
  
  
  RESULTS
  After adjustment for traditional cardiovascular disease risk factors, cigarette smoking was related to elevated levels of C-reactive protein, fibrinogen, and homocysteine. Compared with never smoking cigarettes, self-reported current cigarette smoking was associated with a C-reactive protein level in the detectable (odds ratio, 1.66 [95% CI, 1.40 to 1.97]; P < 0.001) or clinically elevated (odds ratio, 1.98 [CI, 1.57 to 2.51]; P < 0.001) ranges, with elevated levels of fibrinogen (odds ratio, 2.15 [CI, 1.65 to 2.80]; P < 0.001) and homocysteine (odds ratio, 2.10 [CI, 1.62 to 2.74]; P < 0.001). There were positive and significant dose-response relationships between measures of cigarette smoking (cigarettes per day, pack-years, and serum cotinine levels) and elevated levels of novel risk factors.
  
  
  CONCLUSIONS
  These findings suggest that inflammation and hyperhomocysteinemia may be important mechanisms by which smoking promotes atherosclerotic disease.
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Bazzano
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology*; D003367:Cotinine / Q000097:blood; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005340:Fibrinogen / Q000378:metabolism; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications; D007249:Inflammation / Q000150:complications; D016017:Odds Ratio; D012907:Smoking / Q000009:adverse effects*; D014481:United States
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D005340:Fibrinogen; D002097:C-Reactive Protein; D003367:Cotinine