Circulation, Vol 88, 2156-2162, Copyright © 1993 by American Heart Association
JC Witteman, DE Grobbee, HA Valkenburg, AM van Hemert, T Stijnen and A Hofman
BACKGROUND. Cigarette smoking has been recognized as an important risk
factor for cardiovascular disease in men and women. Whether the increased
risk results from an atherogenic effect of smoking is still debated. We
examined the relation between cigarette smoking and atherosclerotic changes
in the abdominal aorta. METHODS AND RESULTS. The association between
cigarette smoking and atherosclerotic changes in the abdominal aorta was
examined in a population-based cohort of 758 women, initially aged 45 to 64
years. All women were examined radiographically for calcified deposits in
the abdominal aorta, which have been shown to represent intimal
atherosclerosis. After 9 years of follow-up, atherosclerotic changes,
indicating development or progression of plaques, could be demonstrated in
37% of women. A direct association was found between atherosclerotic change
and number of cigarettes smoked per day. Compared with women who had never
smoked, the relative risks of those who smoked 1 to 9, 10 to 19, and 20 or
more cigarettes per day were 1.4 (95% confidence interval, 1.0 to 2.0), 2.0
(1.6 to 2.5), and 2.3 (1.8 to 3.0), respectively, after adjustment for age
and other cardiovascular risk factors. Associations of atherosclerotic
change with inhaling habit and duration of smoking were borderline
significant after number of cigarettes smoked per day was taken into
account. Among former smokers, the risk decreased with increasing duration
of stopping but a significant excess risk was still observed after 5 to 10
years since quitting (relative risk, 1.6; 95% confidence interval, 1.1 to
2.2). CONCLUSIONS. These follow-up data support the evidence for an effect
of cigarette smoking on atherosclerosis. The findings suggest that the rate
of atherosclerotic change may be reduced by cessation of smoking, but a
residual effect appears to be present for at least 10 years.
ARTICLES
Cigarette smoking and the development and progression of aortic atherosclerosis. A 9-year population-based follow-up study in women
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
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