Smoking and atherosclerosis in youth

Coronary heart disease is the most common cause of death in the US. Studies have demonstrated that smoking is a major risk factor for coronary heart d isease and that a positive relationship occurs between smoking and aortic a nd coronary atherosclerosis in adults. In 1985, a multicenter cooperative s tudy, Pathobiological Determinants of Atherosclerosis in Youth (PDAY), was organized to study atherosclerosis in trauma victims 15-34 years of age. Re ports from this study have demonstrated that smoking is strongly associated with the prevalence and extent of grossly visible raised lesions in the ab dominal aorta but only weakly associated with similar lesions in the right coronary artery. Coronary arteries from 50 smokers and 50 non-smokers were classified microscopically using a system developed by the American Heart A ssociation in order to determine the stage at which smoking affects atheros clerosis. Smokers had over twice as many advanced lesions, types IV and V, as non-smokers (32 vs 14%) and fewer early lesions, types I, II, III, as no n-smokers (38 vs 62%). The prevalence of advanced or types IV and V lesions (32%) was over twice that of intermediate or type III lesions (14%) in smo kers. The opposite relationship was observed in non-smokers (14 vs 26%). Th is observation suggest that intermediate lesions progress rapidly into adva nced lesions in smokers and that intima formerly having early lesions is re placed by intima with raised lesions. (C) 1999 Elsevier Science Ireland Ltd . All rights reserved.