Relationship between cigarette smoking and novel risk factors for cardiovascular disease in the United States.
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.
Bazzano
Lydia A
LA
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
He
Jiang
J
Muntner
Paul
P
Vupputuri
Suma
S
Whelton
Paul K
PK
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
D015415:Biomarkers; D006710:Homocysteine; D005340:Fibrinogen; D002097:C-Reactive Protein; D003367:Cotinine