Key result
Smoking-associated carotid plaque risk is ~66% lower in older vs younger adults.
Why the study?
The modification effect of age on the association between current smoking and carotid artery plaque in non-diabetic adults was unclear.
Does current smoking increase the presence of carotid artery plaque in non-diabetic adults?
Cross-Sectional (n=9,088)
No
Does current smoking increase the presence of carotid artery plaque in non-diabetic adults?
Current smoking is strongly associated with prevalent carotid artery plaque in young adults under 45, highlighting the importance of early vascular risk assessment and smoking cessation in this demographic.
Answers are grounded in this paper and cite their sources.
Age attenuates smoking-plaque association; leaves open causal modification and requires prospective confirmation before guiding risk stratification.
Objective: To examine whether age modifies the cross-sectional association between current smoking and carotid artery plaque (CAP) in non-diabetic adults. Methods: This retrospective cross-sectional study included 9088 non-diabetic adults undergoing health examinations at the Second Hospital of Hebei Medical University. CAP was assessed via ultrasonography. Smoking was classified as current smoker versus non-smoker (including former smokers). Multivariable logistic regression evaluated the interaction between current smoking and age group (< 45 vs ≥ 45 years). Sensitivity analyses included age-stratified models, a continuous age-by-smoking interaction model, additional adjustment for drinking status, and a male-only analysis. Restricted cubic spline (RCS) analysis characterized the non-linear association between age and CAP. Results: CAP was detected in 1086 (11.95%) participants. A significant age-group-by-smoking interaction was observed (interaction OR = 0.342, 95% CI: 0.223– 0.522; P < 0.001), indicating that the relative smoking-CAP association was weaker among adults aged ≥ 45 years. Current smoking was associated with CAP among adults aged < 45 years in both the interaction model (OR = 2.104, 95% CI: 1.465– 3.022; P < 0.001) and the age-stratified model (OR = 1.754, 95% CI: 1.179– 2.610; P = 0.006), whereas the association was attenuated among adults aged ≥ 45 years. Continuous age-by-smoking and male-only sensitivity analyses showed consistent age-dependent patterns. The continuous RCS model confirmed a significant non-linear relationship ( P < 0.001), visually demonstrating that the risk curves for smokers and non-smokers diverged most widely in early adulthood (< 45 years) and converged at older ages. Male-only analysis yielded a consistent pattern. Conclusion: Current smoking was associated with prevalent CAP predominantly among adults aged < 45 years, and the relative association weakened at older ages. These findings support age-aware interpretation of smoking-related carotid atherosclerosis but should be considered hypothesis-generating because of the cross-sectional design and lack of cumulative smoking exposure data.
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Zhai et al. (2026) conducted a cross-sectional in Carotid artery plaque in non-diabetic adults (n=9,088). Current smoking vs. Non-smoker (including former smokers) was evaluated on Presence of carotid artery plaque (age-group-by-smoking interaction) (Interaction OR 0.342, 95% CI 0.223-0.522, p=<0.001). Current smoking was strongly associated with prevalent carotid artery plaque in adults aged <45 years (OR 2.104), but this relative association was significantly attenuated at older ages (interaction OR 0.342).
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