What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Carotid wall thickening (n=2024). Intervention: Active smoking (pack-years) vs. Never smoking. Primary outcome: Carotid wall thickening (maximum CIMT >1.0 mm) (OR 3.09, 95% CI 1.84-5.34, p=<0.0001).

January 19, 2024Tobacco Induced Diseases2 citationsOpen Access

Smoking and secondhand smoke exposure and carotidintima-media thickness: Baseline data from the Aidai CohortStudy in Japan

Q: What are the key findings of this study?

Higher pack-years of smoking was independently associated with an increased prevalence of carotid wall thickening in both men (OR 3.09 for ≥30 pack-years) and women (OR 3.22 for ≥10 pack-years).

MSMakoto SaitoAngkor Hospital for Children YMYoshihiro MiyakeEhime University KTKeiko TanakaEhime University

Key Result

Higher pack-years of smoking was independently associated with an increased prevalence of carotid wall thickening in both men (OR 3.09 for ≥30 pack-years) and women (OR 3.22 for ≥10 pack-years).

Study Design

Type

Cross-Sectional (n=2,024)

Multicenter

Yes

Structured PICO

Is active smoking and secondhand smoke exposure associated with increased carotid intima-media thickness and carotid wall thickening in Japanese adults?

Population

2,024 Japanese adults aged 34 to 88 years without a history of cardiovascular disease, evaluated for the association between smoking and carotid intima-media thickness.

Exposure

Active smoking (assessed by smoking status and pack-years) and secondhand smoke (SHS) exposure at home and work, evaluated via self-administered questionnaire.

Comparator

Never smoking and never exposed to secondhand smoke at home or work.

Outcome

Carotid wall thickening (defined as maximum CIMT >1.0 mm) and maximum carotid intima-media thickness (CIMT) measured by automated carotid ultrasonography.surrogate

Active smoking, particularly higher pack-years, is strongly associated with increased carotid intima-media thickness and wall thickening in Japanese adults, whereas secondhand smoke exposure did not show a significant association in this cohort.

Main Result

Odds Ratio: 3.09 (95% CI 1.84–5.34)

Absolute Event Rate: 28.3% vs 12.2%

p-value: p=<0.0001

Limitations

Cross-sectional design precludes proving causality
Selection bias due to recruitment from health checkups and higher education level than general population
Self-reported smoking and secondhand smoke exposure may lead to misclassification
Lack of objective measures like cotinine levels
Maximum CIMT defined solely based on the common carotid artery

Abstract

INTRODUCTION: Epidemiological evidence regarding the relationship between smoking and secondhand smoke (SHS) exposure and carotid intima-media thickness (CIMT) has been limited in Asian populations. Employing baseline data from the Aidai Cohort Study, Japan, we evaluated the evidence in this cross-sectional study. METHODS: Study subjects were 727 men aged 35-88 years and 1297 women aged 34-85 years. Information on smoking, SHS exposure, and confounders was obtained through a self-administered questionnaire. An automated carotid ultrasonography device was used to measure the right and left CIMT. The greatest CIMT measurement in the left or right common carotid artery was considered the maximum CIMT, and a maximum CIMT >1.0 mm was indicative of carotid wall thickening. Age, alcohol consumption, leisure time physical activity, hypertension, dyslipidemia, diabetes mellitus, body mass index, waist circumference, employment, and education level were adjusted at one time. RESULTS: The prevalence of carotid wall thickening was 13.0%. The prevalence of never smoking was 30.5% in men and 90.1% in women. Among those who had never smoked, the prevalence of never SHS exposure at home and work was 74.3% and 48.2% in men and 38.3% and 56.3% in women, respectively. Active smoking and pack-years of smoking were independently positively related to carotid wall thickening regardless of sex, although the association with current smoking in women was not significant. Independent positive relationships were shown between former smoking and pack-years of smoking and maximum CIMT in men but not in women. No significant relationships were found between SHS exposure at home and work and carotid wall thickening or maximum CIMT in either men or women. CONCLUSIONS: Active smoking, especially pack-years of smoking, was positively associated with carotid wall thickening in both sexes. Such positive associations with maximum CIMT were found only in men; however, interactions between smoking and sex were not significant.

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