A family history of vascular disease is an independent risk factor for both large-vessel atherosclerosis and small-vessel disease, especially in cases presenting before age 65 years. The estimated sample sizes for case-control studies illustrate how candidate gene studies for ischemic stroke might be made more effective by focusing on these specific phenotypes, in which the genetic component of the disease appears to be strongest.

Abstract-Cigarette smoking is an important modifiable cardiovascular risk factor and pathophysiological mechanisms may include a stiff vascular tree. Although smokers have stiffer arteries, whether smoking cessation is associated with reduced arterial stiffness is not known. We compared never-treated patients with essential hypertension (nϭ554) aged 18 to 80 years (56% females) classified as current smokers (nϭ150), ex-smokers (nϭ136), and nonsmokers (nϭ268). Ex-smokers were categorized into Ͻ1 year, Ͼ1 and Ͻ10 years, and Ͼ10 years of smoking cessation. Key Words: smoking Ⅲ arterial stiffness Ⅲ pulse wave velocity Ⅲ augmentation index Ⅲ hypertension Ⅲ smoking cessation C igarette smoking is one of the most important avoidable causes of cardiovascular diseases worldwide, 1 and arterial stiffness may be one of the underlying pathophysiological mechanisms. Chronic cigarette smoking has been shown to be associated with increased arterial stiffness 2,3 and increases immediately after smoking 1 cigarette. 3 The standard measurement of arterial stiffness, aortic pulse wave velocity (PWV) in conjunction with augmentation index (AIx), an estimate of aortic wave reflection, provide a comprehensive assessment of arterial stiffness. 4 There is evidence that both PWV 5,6 and AIx 7 are independent predictors of cardiovascular events.Smoking cessation is an important lifestyle measure for the prevention of cardiovascular disease, and patients with myocardial infarction may experience as much as a 50% reduction in risk of reinfarction, sudden cardiac death, and total mortality if they quit smoking. 8 However, the speed and magnitude of risk reduction when a smoker quits is debatable, with studies quoting 3 to 20 years of smoking cessation associated with significant risk reductions in coronary artery disease. 8 Whether long-term smoking cessation is associated with a reduction in arterial stiffness compared with chronic smokers is not known. Therefore, we compared differences in arterial stiffness among nonsmokers, ex-smokers, and current smokers in a cross-sectional study. Methods SubjectsA total of 554 untreated subjects aged 18 to 80 years (47.8Ϯ0.6 years, meanϮSEM), 56% female, undergoing assessment for hypertension, were studied. None of the patients had secondary hypertension, coronary artery disease, valvular heart disorders, dysrhythmias, diabetes, heart failure, or renal impairment, and none were taking any vasoactive drugs. Current smokers were defined as those who had smoked Ͼ1 cigarette per day for Ն1 year, nonsmokers as those who had never smoked, and former or ex-smokers as those who had stopped smoking Ն1 month before examination. Ex-smokers were categorized into 3 subgroups according to smoking cessation duration: those who quit cigarette smoking for Ͻ1 year, between 1 and 10 years, and Ͼ10 years.Body weight, height, waist, and hip measurements were recorded in each patient. Body mass index (BMI) was calculated as body weight (kilograms) divided by height (meters squared), and the waist:hip ratio was calculated....

Background and Purpose-Carotid intima-media thickness (IMT) progression rates are increasingly used as an intermediate outcome for vascular risk. The carotid bifurcation (BIF) and internal carotid artery (ICA) are predilection sites for atherosclerosis. IMT measures from these sites may be a better estimate of atherosclerosis than common carotid artery (CCA) IMT. The study aim was to evaluate site-specific IMT progression rates and their relationships to vascular risk factors compared with baseline IMT measurements. Methods-In a community population (nϭ3383), ICA-IMT, BIF-IMT, CCA-IMT, and vascular risk factors were evaluated at baseline and at 3-year follow-up. Only ICA-IMT progression significantly correlated with baseline vascular risk factors (age, male gender, hypertension, diabetes, and smoking). Change in risk factor profile over follow-up, estimated using the Framingham risk score, was a predictor of IMT progression only. For all arterial sites, correlations were stronger, by a factor of 2 to 3, for associations with baseline IMT compared with IMT progression. Conclusions-Progression rates at the ICA rather than the CCA yield greater absolute changes in IMT and better correlations with vascular risk factors. Vascular risk factors correlate more strongly with baseline IMT than with IMT progression. Prospective data on IMT progression and incident vascular events are required to establish the true value of progression data as a surrogate measure of vascular risk. Results-Mean