Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants

PLoS One. 2013 Jun 20;8(6):e66484. doi: 10.1371/journal.pone.0066484. Print 2013.

Abstract

Background: Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications.

Methods: The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n = 341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events.

Results: During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age, packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00-1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk (P = 0.08).

Conclusions: Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / pathology
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / mortality
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / mortality
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology
  • Early Detection of Cancer
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Radiography
  • Risk Factors
  • Smoking / adverse effects*
  • Vascular Calcification / complications*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / mortality

Grant support

The current study is a part of the NELSON study and is supported by the Netherlands Organization for Health Research and Development (ZonMw), Koningin Wilhelmina Fonds (KWF), Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen (RvvZ), Siemens Germany, G. Ph. Verhagen Stichting, Rotterdam Oncologic Thoracic Steering Committee (ROTS), Erasmus Trust Fund, Stichting tegen Kanker and Vlaamse Liga tegen Kanker. No relationship with industry exists. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.