Cigarette smoking and aortic calcification: meta-analysis and systematic review

AIM: Cigarette smoking has been proposed to contribute to aortic stiffness and aortic calcification (AC), although evidence remains inconsistent across populations, anatomical segments, and imaging modalities. We conducted a meta-analysis to clarify the association between current smoking and AC and to examine effect modifiers like as age, sex, and aortic segment. MATERIALS AND METHODS: We conducted a systematic database search from data inception to mid-November 2025. We used random-effects models to estimate the pooled prevalence of AC among current smokers and pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for the association between current smoking and AC. RESULTS: Twelve studies involving 147,972 participants, including 49,329 current smokers, met the inclusion criteria. Most studies were community-based, used computed tomography (CT) imaging, and assessed thoracic or abdominal AC. Current smoking showed a nonsignificant trend toward higher odds of overall AC (random-effects OR= 1.27, 95% CI: 0.98-1.65; P = 0.075). The random-effects model indicated that 37.8% of smokers had detectable AC. Subgroup analyses showed borderline associations in adults aged ≥60 years (OR, 1.48, P = 0.051). No statistically significant association was observed in males (OR, 1.23 CI, 0.85-1.77, P = 0.267), and significant association in CT-based studies (OR, 1.44 CI, 1.04-1.98, P = 0.028). Segment-specific analyses demonstrated a significant association with abdominal AC and a borderline association with thoracic AC. CONCLUSION: Current cigarette smoking was not significantly associated with overall aortic calcification. However, exploratory subgroup analyses identified significant associations with abdominal and CT-detected aortic calcification, warranting confirmation in prospective studies.