Association Between Smoking and Serum GlycA and High-Sensitivity C-Reactive Protein Levels: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

J Am Heart Assoc. 2017 Aug 23;6(8):e006545. doi: 10.1161/JAHA.117.006545.


Background: Inflammation is suggested to be a central feature of atherosclerosis, particularly among smokers. We studied whether inflammatory biomarkers GlycA and high-sensitivity C-reactive protein are associated with cigarette smoking.

Methods and results: A total of 11 509 participants, 6774 from the MESA (Multi-Ethnic Study of Atherosclerosis) and 4735 from ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health) were included. We evaluated the cross-sectional association between multiple measures of smoking behavior and the inflammatory biomarkers, GlycA and high-sensitivity C-reactive protein, using regression models adjusted for demographic, anthropometric, and clinical characteristics. Participants were 57.7±11.1 years old and 46.4% were men. Never, former, and current smokers comprised 51.7%, 34.0%, and 14.3% of the population, respectively. Multivariable-adjusted mean absolute difference in GlycA levels (μmol/L) with 95% confidence interval (CI) were higher for former (4.1, 95% CI, 1.7-6.6 μmol/L) and current smokers (19.9, 95% CI, 16.6-23.2 μmol/L), compared with never smokers. Each 5-unit increase in pack-years of smoking was associated with higher GlycA levels among former (0.7, 95% CI, 0.3-1.1 μmol/L) and current smokers (1.6, 95% CI, 0.8-2.4 μmol/L). Among former smokers, each 5-year increase in time since quitting smoking was associated with lower GlycA levels (-1.6, 95% CI, -2.4 to -0.8 μmol/L) and each 10-unit increase in number of cigarettes/day was associated with higher GlycA among current smokers (2.8, 95% CI, 0.5-5.2 μmol/L). There were similar significant associations between all measures of smoking behavior, and both log-transformed GlycA and high-sensitivity C-reactive protein.

Conclusions: Acute and chronic exposure to tobacco smoking is associated with inflammation, as quantified by both GlycA and high-sensitivity C-reactive protein. These biomarkers may have utility for the study and regulation of novel and traditional tobacco products.

Keywords: atherosclerosis; inflammation; prevention; risk assessment; smoking.

Publication types

  • Multicenter Study

MeSH terms

  • Acute-Phase Proteins / analysis*
  • Adult
  • Aged
  • Aged, 80 and over
  • Atherosclerosis / blood*
  • Atherosclerosis / diagnosis
  • Atherosclerosis / epidemiology
  • Biomarkers / blood
  • Brazil / epidemiology
  • C-Reactive Protein / analysis*
  • Cross-Sectional Studies
  • Female
  • Glycosylation
  • Humans
  • Inflammation / blood*
  • Inflammation / diagnosis
  • Inflammation / epidemiology
  • Inflammation Mediators / blood*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Smoking / adverse effects*
  • Smoking / blood
  • Smoking / epidemiology
  • Time Factors
  • United States / epidemiology


  • Acute-Phase Proteins
  • Biomarkers
  • Inflammation Mediators
  • C-Reactive Protein