Circulation, Vol 90, 2905-2908, Copyright © 1994 by American Heart Association
GS Tell, JF Polak, BJ Ward, SJ Kittner, PJ Savage and J Robbins
BACKGROUND: Cigarette smoking has been associated with increased risk of
atherosclerotic diseases in hospital-based studies and in studies of
middle-aged populations but not in population-based studies of older adults
with and without clinical cardiovascular disease. METHODS AND RESULTS: We
investigated the relation of smoking to carotid artery atherosclerotic
disease, expressed as intimal-medial wall thickness and arterial lumen
narrowing (stenosis) measured by ultrasound. Subjects were 5116 older
adults participating in the baseline examination of the Cardiovascular
Health Study, a community-based study of cardiovascular diseases in older
age. With increased smoking there was significantly greater internal and
common carotid wall thickening and internal carotid stenosis: current
smokers > former smokers > never-smokers; for instance, the
unadjusted percent stenosis was 24%, 20%, and 16%, respectively (P <
.0001). A significant dose-response relation was seen with pack-years of
smoking. These findings persisted after adjusting for other cardiovascular
risk factors and were also confirmed when analyses were restricted to those
without prevalent cardiovascular disease. The difference in internal
carotid wall thickness between current smokers and nonsmokers was greater
than the difference associated with 10 years of age among never-smoking
participants (0.39 mm versus 0.31 mm). Among all participants, the
prevalence of clinically significant (> or = 50%) internal carotid
stenosis increased from 4.4% in never-smokers to 7.3% in former smokers to
9.5% in current smokers (P < .0001). CONCLUSIONS: These findings extend
previous reports of a positive relation between smoking and carotid artery
disease to a population-based sample of older adults using several
different indicators of atherosclerotic disease.
ARTICLES
Relation of smoking with carotid artery wall thickness and stenosis in older adults. The Cardiovascular Health Study. The Cardiovascular Health Study (CHS) Collaborative Research Group
Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC.
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