title: Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants.
abstract: BACKGROUND
  Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications.
  
  
  METHODS
  The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n = 341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events.
  
  
  RESULTS
  During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age, packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00-1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk (P = 0.08).
  
  
  CONCLUSIONS
  Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. pjairam@umcutrecht.nl
authors.forename: Pushpa M
authors.initials: PM
authors.lastname: Jairam
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.forename: Willem P T h M
authors.initials: WP
authors.lastname: Mali
authors.forename: Ivana
authors.initials: I
authors.lastname: Isgum
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Carlijn
authors.initials: C
authors.lastname: van der Aalst
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011859:Radiography; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D061205:Vascular Calcification / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality