title: Association of tobacco use and cessation with coronary atherosclerosis.
abstract: The impact of tobacco use and cessation on atherogenesis remains unclear. We aimed to study the association of tobacco use and prior cessation with the presence, extent and severity of atherosclerosis on coronary computed tomographic angiography (CTA).
  
  
  
  We examined 1798 consecutive symptomatic patients without known coronary artery disease (CAD) referred for CTA, stratified by smoking status (never, current [within 30 days], or former [>30 days before CTA]). Plaque severity (none, <50%, ≥50% stenosis), composition (non-calcified [NCP], partially calcified [PCP], or calcified plaque [CP]), and segment involvement score (SIS) were visually graded. Multivariate analysis was performed, adjusting for CAD risk factors and cholesterol lowering medication use.
  
  
  
  The median age of patients was 50 years [IQR:42-58] (61% male), with 74% never smokers, 12% current smokers, and 14% former smokers (median quit duration = 12 years [IQR:3-26]). Smoking exposure in former versus current smokers was 11 [IQR:5-25] and 10 [IQR:2-20] pack-years, respectively (p = 0.01). Compared to never smokers, current smokers demonstrated an increased odds ratio of all plaque types (adjusted OR: any NCP = 1.55 [95% CI 1.04-2.32], p = 0.03; any PCP = 1.61 [1.10-2.37], p = 0.02; any CP = 1.93 [1.32-2.81], p = 0.001), non-obstructive CAD (aOR = 1.47 [1.04, 2.07], p = 0.03), obstructive CAD (aOR = 1.81 [1.01-3.24], p = 0.047), and SIS > 4 (aOR = 1.60 [1.04-2.46], p = 0.03). Compared to current smoking, prior smoking cessation (≥12 years) was associated with a decreased odds ratio of any NCP (aOR = 0.42 [0.19-0.90], p = 0.03), CP (aOR = 0.43 [0.22-0.84], p = 0.02), and obstructive CAD (aOR = 0.40, [0.15-0.98], p = 0.048).
  
  
  
  Current smoking is independently associated with the presence and extent of coronary plaque, and a higher risk of non-obstructive and obstructive CAD compared to never smoking. Prior smoking cessation correlated with improvements in CTA-identified plaque measures.
authors.affiliation: Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD, USA. Electronic address: michael.k.cheezum.mil@mail.mil.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Cheezum
authors.affiliation: Uniformed Services University of Health Sciences, Bethesda, MD, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kim
authors.affiliation: Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil; Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Department of Medicine (Cardiology Service), Womack Army Medical Center, Ft. Bragg, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kassop
authors.affiliation: Uniformed Services University of Health Sciences, Bethesda, MD, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nissen
authors.affiliation: Department of Medicine (Cardiology Service), San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Thomas
authors.affiliation: Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Binh
authors.initials: B
authors.lastname: Nguyen
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Glynn
authors.affiliation: Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, RI, USA.
authors.forename: Nishant R
authors.initials: NR
authors.lastname: Shah
authors.affiliation: Department of Medicine (Cardiology Service), Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Atherosclerosis; Coronary artery disease; Coronary computed tomographic angiography; Smoking; Tobacco