Arterial intima-media thickness, endothelial function, and apolipoproteins in adolescents frequently exposed to tobacco smoke

Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2):196-203. doi: 10.1161/CIRCOUTCOMES.109.857771. Epub 2010 Mar 2.


Background: Exposure to tobacco smoke is associated with markers of preclinical atherosclerosis in adults, but its effect on arterial structure in adolescents is unknown.

Methods and results: Healthy 13-year-old adolescents from the atherosclerosis prevention trial STRIP were studied. Maximum carotid and aortic intima-media thickness and brachial artery flow-mediated dilation were measured in 494 adolescents using high-resolution ultrasound. Serum lipid, lipoprotein, and apolipoprotein (Apo) A-I and B concentrations were determined using standard methods. Exposure to tobacco smoke was measured annually between ages 8 and 13 years using serum cotinine concentrations, analyzed with gas chromatography. To define longitudinal exposure, cotinine values of children having serum cotinine measured 2 to 6 times during follow-up were averaged and divided into tertiles (exposure groups): low (n=160), intermediate (n=171), and high (n=163). Adolescents with higher longitudinal exposure to tobacco smoke had increased carotid intima-media thickness (exposure groups [mean+/-SD]: low, 0.502+/-0.079 mm; intermediate, 0.525+/-0.070 mm; high, 0.535+/-0.066 mm; P<0.001) and increased aortic intima-media thickness (exposure groups: low, 0.527+/-0.113 mm; intermediate, 0.563+/-0.139 mm; high, 0.567+/-0.126 mm; P=0.008). The flow-mediated dilation decreased when cotinine level increased (exposure groups: low, 10.43+/-4.34%; intermediate, 9.78+/-4.38%; high, 8.82+/-4.14%; P=0.004). Moreover, ApoB (P=0.014) and ApoB/ApoA-I ratio (P=0.045) increased with increase in cotinine level. The associations between tobacco smoke exposure and ultrasound variables were unchanged after adjusting for traditional atherosclerosis risk factors and for ApoB.

Conclusions: Frequent exposure to tobacco smoke is independently associated with arterial changes of preclinical atherosclerosis and increased ApoB levels among healthy adolescents. Clinical Trial Registration- Identifier: NCT00223600.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Aorta, Abdominal / diagnostic imaging
  • Aorta, Abdominal / drug effects*
  • Apolipoprotein A-I / blood*
  • Apolipoproteins B / blood*
  • Atherosclerosis / diagnosis
  • Atherosclerosis / etiology*
  • Atherosclerosis / physiopathology
  • Atherosclerosis / prevention & control
  • Biomarkers / blood
  • Brachial Artery / drug effects
  • Brachial Artery / physiopathology
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Common / drug effects*
  • Child
  • Chromatography, Gas
  • Cotinine / blood
  • Endothelium, Vascular / diagnostic imaging
  • Endothelium, Vascular / drug effects*
  • Endothelium, Vascular / physiopathology
  • Female
  • Finland
  • Humans
  • Longitudinal Studies
  • Male
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Smoking Cessation
  • Time Factors
  • Tobacco Smoke Pollution / adverse effects*
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / drug effects*
  • Tunica Media / diagnostic imaging
  • Tunica Media / drug effects*
  • Ultrasonography, Doppler
  • Vasodilation / drug effects


  • APOA1 protein, human
  • Apolipoprotein A-I
  • Apolipoproteins B
  • Biomarkers
  • Tobacco Smoke Pollution
  • Cotinine

Associated data