Lydia A. Bazzano, MD, PhD; Jiang He, MD, PhD; Paul Muntner, PhD; Suma Vupputuri, PhD; Paul K. Whelton, MD, MSc
Grant Support: In part by grant RO1 HL60300 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue SL18, New Orleans, LA 70112.
Current Author Addresses: Dr. Bazzano: Department of Internal Medicine, Beth Israel Deaconess Hospital, 330 Brookline Avenue, Deaconess Building 300, Boston, MA 02215.
Drs. He, Muntner, and Whelton: Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue SL18, New Orleans, LA 70112.
Dr. Vupputuri: National Institute of Environmental Health Sciences, 111 Alexander Drive, Research Triangle Park, NC 27709.
Author Contributions: Conception and design: L.A. Bazzano, J. He.
Analysis and interpretation of the data: L.A. Bazzano, J. He, P. Muntner.
Drafting of the article: L.A. Bazzano, J. He.
Critical revision of the article for important intellectual content: L.A. Bazzano, J. He, P. Muntner, S. Vupputuri, P.K. Whelton.
Final approval of the article: L.A. Bazzano, J. He, P. Muntner, S. Vupputuri, P.K. Whelton.
Statistical expertise: L.A. Bazzano, J. He, P. Muntner.
Obtaining of funding: J. He.
Administrative, technical, or logistic support: J. He.
Bazzano LA, He J, Muntner P, Vupputuri S, Whelton PK. Relationship between Cigarette Smoking and Novel Risk Factors for Cardiovascular Disease in the United States. Ann Intern Med. 2003;138:891-897. doi: 10.7326/0003-4819-138-11-200306030-00010
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Published: Ann Intern Med. 2003;138(11):891-897.
Few studies have examined the relationship between cigarette smoking and novel risk factors for cardiovascular disease in a general population or have included a biochemical marker of current smoking.
To examine the relationship between cigarette smoking and serum C-reactive protein, fibrinogen, and homocysteine levels.
The U.S. general population.
4187 current smokers, 4791 former smokers, and 8375 never-smokers 18 years of age or older who participated in the Third National Health and Nutrition Examination Survey conducted between 1988 and 1994.
Serum C-reactive protein levels were categorized as detectable (2.2 to 9.9 mg/L) or clinically elevated ( 10 mg/L), and fibrinogen and homocysteine levels were defined as elevated if in the 85th percentile or greater (11.1 mol/L and 12.7 mmol/L, respectively).
After adjustment for traditional cardiovascular disease risk factors, cigarette smoking was related to elevated levels of C-reactive protein, fibrinogen, and homocysteine. Compared with never smoking cigarettes, self-reported current cigarette smoking was associated with a C-reactive protein level in the detectable (odds ratio, 1.66 [95% CI, 1.40 to 1.97]; P < 0.001) or clinically elevated (odds ratio, 1.98 [CI, 1.57 to 2.51]; P < 0.001) ranges, with elevated levels of fibrinogen (odds ratio, 2.15 [CI, 1.65 to 2.80]; P < 0.001) and homocysteine (odds ratio, 2.10 [CI, 1.62 to 2.74]; P < 0.001). There were positive and significant doseresponse relationships between measures of cigarette smoking (cigarettes per day, pack-years, and serum cotinine levels) and elevated levels of novel risk factors.
These findings suggest that inflammation and hyperhomocysteinemia may be important mechanisms by which smoking promotes atherosclerotic disease.
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Cardiology, Tobacco, Alcohol, and Other Substance Abuse, Coronary Risk Factors, Smoking, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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