title: Cigarette smoking worsens systemic inflammation in persons with metabolic syndrome.
abstract: BACKGROUND
  Emerging data suggests that the combination of smoking and metabolic syndrome (MetS) markedly increases cardiovascular disease risk well beyond that of either condition. In this study we assess if this interaction can be explained by an additive increase in the risk of systemic inflammation by MetS and cigarette smoking.
  
  
  METHODS
  We evaluated 5,503 healthy non-diabetic Brazilian subjects (mean age of 43 ± 10 years, 79% males). Participants were divided into sub-groups of smokers and non-smokers with or without MetS. High-sensitivity C reactive protein (hs-CRP) was measured to assess degree of underlying inflammation.
  
  
  RESULTS
  Overall (19%) had hs-CRP > 3 mg/L. In adjusted regression analyses, compared to non-smokers, there was a 0.19 mg/L (95% CI: 0.05, 0.32) increase in hs-CRP among smokers in the entire population and 0.63 mg/L (95% CI: 0.26, 1.01) increase among smokers with MetS while there was no significant increase among smokers without MetS (β = 0.09 95% CI: -0.05, 0.24). In a fully adjusted logistic regression model, smokers compared to non-smokers were 55% more likely to have elevated hs-CRP in the entire population (OR 1.55, 95% CI: 1.25, 1.92) and more than twice as likely to have elevated hs-CRP if they had MetS ( OR 2.05, 95% CI: 1.40, 3.01) while the risk was non-significant among those without MetS (OR = 1.29, 95% CI: 0.98, 1.69).
  
  
  CONCLUSIONS
  The study demonstrates an additive effect of cigarette smoking on the risk of systemic inflammation in MetS thus highlighting the need for determining smoking status among those with MetS and aggressively targeting smoking cessation in this population.
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Jamal
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Ehimen C
authors.initials: EC
authors.lastname: Aneni
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Shaharyar
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Shozab S
authors.initials: SS
authors.lastname: Ali
authors.affiliation: Center for Research and Grants, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Parris
authors.affiliation: The Ciccarone Preventive Cardiology Center at Johns Hopkins Medical Institution, Baltimore, MD, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA ; Lipid Institute (Incor), Sao Paolo, Brazil.
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.affiliation: The Ciccarone Preventive Cardiology Center at Johns Hopkins Medical Institution, Baltimore, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: The Ciccarone Preventive Cardiology Center at Johns Hopkins Medical Institution, Baltimore, MD, USA.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA ; Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA ; Herbert Wertheim School of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Agatston
authors.affiliation: Preventive Medical Center, Hospital Israelita, Sao Paolo, Brazil.
authors.forename: Raquel D
authors.initials: RD
authors.lastname: Conceição
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA ; Herbert Wertheim School of Medicine, Florida International University, Miami, Florida, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Preventive Medical Center, Hospital Israelita, Sao Paolo, Brazil.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Carvalho
authors.affiliation: Preventive Medical Center, Hospital Israelita, Sao Paolo, Brazil ; Lipid Institute (Incor), Sao Paolo, Brazil.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, Florida, USA ; The Ciccarone Preventive Cardiology Center at Johns Hopkins Medical Institution, Baltimore, MD, USA ; Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA ; Herbert Wertheim School of Medicine, Florida International University, Miami, Florida, USA ; Baptist Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida, USA.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
keywords: Cardiovascular disease risk; Cigarette smoking; High sensitivity C-reactive protein; Metabolic syndrome; Systemic inflammation