RELATION OF SMOKING WITH CAROTID-ARTERY WALL THICKNESS AND STENOSIS IN OLDER ADULTS - THE CARDIOVASCULAR HEALTH STUDY

Background Cigarette smoking has been associated with increased risk o f atherosclerotic diseases in hospital-based studies and in studies of middle-aged populations but not in population-based studies of older adults with and without clinical cardiovascular disease. Methods and R esults We investigated the relation of smoking to carotid artery ather osclerotic disease, expressed as intimal-medial wall thickness and art erial lumen narrowing (stenosis) measured by ultrasound. Subjects were 5116 older adults participating in the baseline examination of the Ca rdiovascular Health Study, a community-based study of cardiovascular d iseases in older age. With increased smoking there was significantly g reater internal and common carotid wall thickening and internal caroti d stenosis: current smokers>former smokers>never-smokers; for instance , the unadjusted percent stenosis was 24%, 20%, and 16%, respectively (P<.0001). A significant dose-response relation was seen with pack-yea rs of smoking. These findings persisted after adjusting for other card iovascular risk factors and were also confirmed when analyses were res tricted to those without prevalent cardiovascular disease. The differe nce in internal carotid wall thickness between current smokers and non smokers was greater than the difference associated with 10 years of ag e among never-smoking participants (0.39 mm versus 0.31 mm). Among all participants, the prevalence of clinically significant (greater than or equal to 50%) internal carotid stenosis increased from 4.4% in neve r-smokers to 7.3% in former smokers to 9.5% in current smokers (P<.000 1). Conclusions These findings extend previous reports of a positive r elation between smoking and carotid artery disease to a population-bas ed sample of older adults using several different indicators of athero sclerotic disease.