Cardiovascular
Association of smoking intensity with prevalence of radiographic abdominal aortic calcification: A cross-sectional study among community-dwelling older men Shabir Sarwary* Shabir Sarwary John Schousboe Pawel Szulc Lynn Marshall
BACKGROUND
Abdominal aortic calcification (AAC) is a marker of cardiovascular risk. Smoking is associated with severe AAC; however, prior studies on this topic assessed smoking as a binary variable without accounting for the specific smoking habits.
METHODS
The association between smoking and AAC was assessed in 4,707 men from the Osteoporotic Fractures in Men Study. At baseline, smoking history (age initiated, frequency, age they quit) was assessed via self-reported questionnaires. Pack-years and age started smoking was categorized to 5 levels, quartiles for those who are current or former smokers. Time since quitting smoking was categorized to 6 levels, quartiles for those who were former smokers. AAC was assessed on the lateral lumbar spine radiographs using Kauppila’s semiquantitative score. AAC severity was categorized as none (0, n=781), mild (1-4, n=1,865), and moderate/severe (5-24, n=2,061). Prevalence odds ratios (POR) and 95% CI were calculated using multinomial logistic regression adjusted for age, education, and social class status.
RESULTS
In the adjusted model, the odds of mild AAC were higher in the highest quartile of pack-years of smoking (42–111) compared to never-smokers (POR=2.46, 95% CI: 1.75, 3.44). Similarly, the odds of moderate/severe AAC were higher in the highest quartile of pack-years of smoking compared to never-smokers (POR = 8.33, 95% CI: 5.98, 11.59). POR increased across the quartiles of smoking for both mild and moderate/severe AAC. An overall pattern of decreasing POR was observed for both mild and moderate/severe AAC categories with increasing categories of time since quitting smoking, such as those with the most time since quitting smoking having the lowest prevalence of AAC.
DISCUSSION
In this cohort of older men, heavy smoking was strongly associated with higher odds of AAC. Since smoking contributes to inflammation and oxidative stress, smoking cessation may result in slowing the progression of AAC among former smokers.