Table 2.11Relationship between tobacco use and atherosclerosis or subclinical atherosclerosis

StudyDesign/populationAtherosclerosis measureMeasure of tobacco useFindingsComments
Berenson et al. 1998Autopsy study of a biracial cohort of children and young adults dying accidentally who previously participated in the Bogalusa Heart Study

Includes 204 autopsies for which tobacco use history was available in 49 (15 smokers, 34 nonsmokers)		Pathologic study of the coronary arteries and the aorta; lesions classified according to American Heart Association (AHA) grading systemHistory of tobacco use from a questionnaire administered at 8 years of age and older
  • Mean percentage of the abdominal aorta involved in fibrous plaque lesions (AHA grade 3–5) was higher in smokers (1.22% ± 0.62% vs. 0.12% ± 0.07%, p = 0.02)
  • Mean percentage of the coronary arteries involved with fatty streaks (AHA grade 1–2) was greater in smokers (8.27% ± 3.43% vs. 2.89% ± 0.83%, p = 0.04)
  • Increased number of risk factors increased the amount of atherosclerosis
Smoking is related to atherosclerosis in the coronary arteries and the abdominal aorta in those with a history of smoking
Kádár et al. 1999Autopsy study of adolescents and young adults (aged 15–34 years) dying accidentally (n = 214)

Cross-sectional analysis of the relationship of postmortem risk factors to measures of atherosclerosis

Conducted in 5 countries: Cuba, Germany, Hungary, Mexico, and Sri Lanka		Pathologic study of the left anterior descending coronary artery, ascending aorta, and abdominal aorta; lesions classified according to AHA grading systemData available on smoking status from 68 subjects in Hungary only (33 smokers)
  • Prevalence of AHA grade 3–5 lesions higher in smokers than in nonsmokers (46% vs. 14%, p <0.02)
  • No effect seen in the coronary arteries
Smoking is related to advanced lesions in the abdominal aorta of young smokers
Zieske et al. 1999, 2005As above, additional analyses of the proximal left anterior descending coronary artery (n = 1,128)As above, except left anterior descending coronary artery studiedAs above, adjustment for other cardiovascular risk factors
  • Smoking was strongly associated with AHA grade lesion (p <0.0002)
  • Smoking was more likely to have any AHA lesion (OR = 1.34 [1.06–1.70])
  • Smoking was associated with increased prevalence of grade 5 lesions (the most advanced) among those with grade 4 or 5 lesions (OR = 9.61 [2.34–39.57])
  • In individuals with no other risk factors, grade 5 lesions were only present in smokers
Smoking increases atherosclerosis in the left anterior descending coronary artery and is associated with rapid progression of lesions to advanced AHA grade
McGill et al. 2000, 2008; McMahan et al. 2005, 2006Autopsy study of adolescents and young adults (aged 15–34 years) dying accidentally (n = 1,110)

Cross-sectional analysis of the relationship of postmortem risk factors to measures of atherosclerosis

Conducted at multiple centers across the United States, cohort is biracial		Pathologic study of the right coronary artery and abdominal aorta; lesions classified according to AHA grading systemPostmortem thiocyanate level; tobacco use defined as level ≥90 micromole/L Other cardiovascular risk factors assessed as well
  • In the abdominal aorta, fatty streaks are more extensive than in nonsmokers (p <0.05)
  • In the abdominal aorta, >20 years of age, smokers have more extensive involvement with raised lesions (p <0.03 [20–24 years] to <00001 [>25 years])
  • No statistically significant effects in the right coronary artery
  • Increased number of risk factors increased the amount of atherosclerosis
Smoking is directly related to measurable atherosclerosis in the abdominal aorta and particularly to more advanced lesions, and it increases atherosclerosis in the presence of other risk factors
Raitakari et al. 2003Relationship of carotid artery intima-media thickness measured 21 years after serial cardiovascular risk evaluation in youth 3–18 years of age (n = 2,229)

Conducted in Finland		Carotid artery intima-media thicknessSmoking status defined as smoking at least weekly by history
  • In a multivariable model including age, gender, body mass index, low-density lipoprotein cholesterol, and systolic blood pressure, adolescent smoking significantly predicted future carotid artery intima-media thickness (p <0.02)
  • Multiple risk factors increased carotid artery intima-media thickness
Smoking in youth predicts future carotid artery intima-media thickness
Loria et al. 2007Relationship of coronary calcium measured by computed tomography (CT) scan at 33–45 years of age to risk factors measured beginning at 18–30 years of age and at intervals in between (n = 3,043)

Conducted in a biracial cohort in the United States at 4 sites		Presence of coronary calciumSmoking status defined by history, cigarettes smoked/day calculated
  • In a multivariable model including all cardiovascular risk factors, tobacco use at 18–30 years of age predicted future coronary calcium after adjustment for smoking status at the time of the CT scan (OR = 1.5 [1.3–1.7] per 10 cigarettes smoked/day)
Smoking as a young adult is associated with the presence of coronary calcium 15 years later in a dose-dependent fashion

Note: L = liter; OR = odds ratio.

From: 2, The Health Consequences of Tobacco Use Among Young People

Cover of Preventing Tobacco Use Among Youth and Young Adults
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health.
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