Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health)

Background: there is a need to identify sensitive biomarkers of early tobacco-related cardiovascular disease. we examined the association of smoking status,burden,time since quitting,and intensity,with markers of inflammation and subclinical atherosclerosis.methods and results: we studied 14 103 participants without clinical cardiovascular disease in elsa-brasil (brazilian longitudinal study of adult health). we evaluated baseline cross-sectional associations between smoking parameters and inflammation (high-sensitivity c-reactive protein [hscrp]) and measures of subclinical atherosclerosis (carotid intima-media thickness,ankle-brachial index,and coronary artery calcium [cac]). the cohort included 1844 current smokers,4121 former smokers,and 8138 never smokers. mean age was 51.7±8.9 years; 44.8% were male. after multivariable adjustment,compared with never smokers,current smokers had significantly higher levels of hscrp (β=0.24,0.19-0.29 mg/l; p<0.001) and carotid intima-media thickness (β=0.03,0.02-0.04 mm; p<0.001) and odds of ankle-brachial index ≤1.0 (odds ratio: 2.52; 95% confidence interval,2.06-3.08; p<0.001) and cac >0 (odds ratio: 1.83; 95% confidence interval,1.46-2.30; p<0.001). among former and current smokers,pack-years of smoking (burden) were significantly associated with hscrp (p<0.001 and p=0.006,respectively) and cac (p<0.001 and p=0.002,respectively). among former smokers,hscrp and carotid intima-media thickness levels and odds of ankle-brachial index ≤1.0 and cac >0 were lower with increasing time since quitting (p<0.01). among current smokers,number of cigarettes per day (intensity) was positively associated with hscrp (p<0.001) and cac >0 (p=0.03) after adjusting for duration of smoking.conclusions: strong associations were observed between smoking status,burden,and intensity with inflammation (hscrp) and subclinical atherosclerosis (carotid intima-media thickness,ankle-brachial index,cac). these markers of early cardiovascular disease injury may be used for the further study and regulation of traditional and novel tobacco products. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.