title: Current but not past smoking increases the risk of cardiac events: insights from coronary computed tomographic angiography.
abstract: OBJECTIVE
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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: Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA.
authors: Rine
authors: R
authors: Nakanishi
authors: Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Daniel S
authors: DS
authors: Berman
authors: Department of Medicine, Harbor UCLA Medical Center, Torrance, CA, USA.
authors: Matthew J
authors: MJ
authors: Budoff
authors: Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Heidi
authors: H
authors: Gransar
authors: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors: Stephan
authors: S
authors: Achenbach
authors: Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA.
authors: Mouaz
authors: M
authors: Al-Mallah
authors: Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors: Daniele
authors: D
authors: Andreini
authors: Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Filippo
authors: F
authors: Cademartiri
authors: Tennessee Heart and Vascular Institute, Hendersonville, TN, USA.
authors: Tracy Q
authors: TQ
authors: Callister
authors: Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Oklahoma Heart Institute, Tulsa, OK, USA.
authors: Victor Y
authors: VY
authors: Cheng
authors: William Beaumont Hospital, Royal Oaks, MI, USA.
authors: Kavitha
authors: K
authors: Chinnaiyan
authors: Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada.
authors: Benjamin J W
authors: BJ
authors: Chow
authors: Baptist Cardiac and Vascular Institute, Miami, FL, USA.
authors: Ricardo
authors: R
authors: Cury
authors: Capitol Cardiology Associates, Albany, NY, USA.
authors: Augustin
authors: A
authors: Delago
authors: Division of Cardiology, DeutschesHerzzentrumMünchen, Munich, Germany.
authors: Martin
authors: M
authors: Hadamitzky
authors: Division of Cardiology, DeutschesHerzzentrumMünchen, Munich, Germany.
authors: Jörg
authors: J
authors: Hausleiter
authors: Department of Radiology, Medical University of Innsbruck, Innsbuck, Austria.
authors: Gudrun
authors: G
authors: Feuchtner
authors: Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea.
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland.
authors: Philipp A
authors: PA
authors: Kaufmann
authors: Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, USA.
authors: Jonathon
authors: J
authors: Leipsic
authors: Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
authors: Fay Y
authors: FY
authors: Lin
authors: Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Erica
authors: E
authors: Maffei
authors: Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors: Gianluca
authors: G
authors: Pontone
authors: William Beaumont Hospital, Royal Oaks, MI, USA.
authors: Gilbert
authors: G
authors: Raff
authors: Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors: Leslee J
authors: LJ
authors: Shaw
authors: Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA.
authors: Todd C
authors: TC
authors: Villines
authors: Department of Public Health, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
authors: Allison
authors: A
authors: Dunning
authors: Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA jkm2001@med.cornell.edu runone123@gmail.com.
authors: James K
authors: JK
authors: Min
mesh_terms: D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000209:etiology; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Coronary atherosclerosis; Coronary computed tomographic angiography; Major adverse cardiovascular risk; Smoking risk