title: Lung and Heart Diseases Are Better Predicted by Pack-Years than by Smoking Status or Duration of Smoking Cessation in HIV Patients.
abstract: The objective of this study was to assess the relationship of pack-years smoking and time since smoking cessation with risk of lung and heart disease.
  
  
  
  We investigated the history of lung and heart disease in 903 HIV-infected patients who had undergone thoracic computed tomography (CT) imaging stratified by smoking history. Multimorbidity lung and heart disease (MLHD) was defined as the presence of ≥ 2 clinical or subclinical lung abnormalities and at least one heart abnormality.
  
  
  
  Among 903 patients, 23.7% had never smoked, 28.7% were former smokers and 47.6% were current smokers. Spirometry indicated chronic obstructive pulmonary disease in 11.4% of patients and MLHD was present in 53.6%. Age, male sex, greater pack-years smoking history and smoking cessation less than 5 years earlier vs. more than 10 years earlier (OR 2.59, 95% CI 1.27-5.29, p = 0.009) were independently associated with CT detected subclinical lung and heart disease. Pack-years smoking history was more strongly associated with MLHD than smoking status (p<0.001).
  
  
  
  MLHD is common even among HIV-infected patients who never smoked and pack- years smoking history is a stronger predictor than current smoking status of MLHD. A detailed pack-years smoking history should be routinely obtained and smoking cessation strategies implemented.
authors.affiliation: Modena HIV Metabolic Clinic, UNIMORE, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
authors.affiliation: Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: André
authors.initials: A
authors.lastname: Gomes
authors.affiliation: Modena HIV Metabolic Clinic, UNIMORE, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.affiliation: Modena HIV Metabolic Clinic, UNIMORE, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Marchi
authors.affiliation: Modena HIV Metabolic Clinic, UNIMORE, Modena, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Radiology Unit, UNIMORE, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Besutti
authors.affiliation: Radiology Unit, UNIMORE, Modena, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Scaglioni
authors.affiliation: Radiology Unit, UNIMORE, Modena, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.affiliation: Department of Radiology, University of British Columbia, Vancouver, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Man
authors.affiliation: Department of Medicine (Respiratory Division), University of British Columbia, Vancouver, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Sin
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000453:epidemiology; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008171:Lung Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013997:Time Factors