Smoking Cessation and Cardiovascular Disease Risk Factors: Results from the Third National Health and Nutrition Examination Survey

Abstract

BackgroundCigarette smoking is a major risk factor for the development and progression of cardiovascular disease. While smoking is associated with increased levels of inflammatory markers and accelerated atherosclerosis, few studies have examined the impact of smoking cessation on levels of inflammatory markers. The degree and rate at which inflammation subsides after smoking cessation are uncertain. It also remains unclear as to whether traditional risk factors can adequately explain the observed decline in cardiovascular risk following smoking cessation.Methods and FindingsUsing data from 15,489 individuals who participated in the Third National Health and Nutrition Examination Survey (NHANES III), we analyzed the association between smoking and smoking cessation on levels of inflammatory markers and traditional cardiovascular risk factors. In particular, we examined changes in C-reactive protein, white blood cell count, albumin, and fibrinogen. Inflammatory markers demonstrated a dose-dependent and temporal relationship to smoking and smoking cessation. Both inflammatory and traditional risk factors improved with decreased intensity of smoking. With increased time since smoking cessation, inflammatory markers resolved more slowly than traditional cardiovascular risk factors.ConclusionInflammatory markers may be more accurate indicators of atherosclerotic disease. Inflammatory markers returned to baseline levels 5 y after smoking cessation, consistent with the time frame associated with cardiovascular risk reduction observed in both the MONICA and Northwick Park Heart studies. Our results suggest that the inflammatory component of cardiovascular disease resulting from smoking is reversible with reduced tobacco exposure and smoking cessation.

Associations of Cigarette Smoking With Subclinical Inflammation and Atherosclerosis: ELSA‐Brasil (The Brazilian Longitudinal Study of Adult Health)

“…In addition, hsCRP is associated with atherosclerotic processes40 and thus may also be directly involved in cardiovascular injury. The high sensitivity of this test, as indicated by significant differences via secondhand smoking exposure and consistent results for different indices of tobacco exposure in ELSA‐Brasil and across other studies,5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 41 highlights hsCRP as a favorable marker for monitoring hazardous health effects of tobacco exposure.…”

“…These studies have generally shown higher levels of hsCRP among current and former smokers compared with nonsmokers5, 6, 9, 10, 12, 13, 14, 15 and decreased levels after smoking cessation, albeit slower than systolic blood pressure and total cholesterol and LDL‐C 8, 11, 12. Calculating the probability of CAC onset following smoking exposure in the Heinz Nixdorf Recall study also demonstrated that onset of CAC was expedited by 10 years among current smokers and 5 years among former smokers compared with never smokers 16.…”

The Relationship Between Smoking Intensity and Subclinical Cardiovascular Injury: The Multi-Ethnic Study of Atherosclerosis (MESA)

“…18,[47][48][49][50] The association of smoking and inflammation is also supported by epidemiologic studies which demonstrated a positive association of cigarettes per day with hsCRP, white blood cell count, and fibrinogen in univariate analyses. 25 Data from this study indicates that smoking intensity is independently associated with inflammation in a dose dependent manner and that hsCRP is the most sensitive biomarker of this association as compared to IL-2, IL-6, and TNF-alpha.…”

Effect of smoking cessation on the risk of dementia: a longitudinal study

“…Since cerebrovascular infarction is the key pathophysiological mechanism for vascular dementia, the risk factors of cerebrovascular diseases, which include smoking,43, 44 are also considered to be risk factors of vascular dementia. As smoking cessation reduces the risk of cardiovascular disease due to decreased inflammatory markers and oxidative stress45, 46, 47 upon smoking cessation, similar mechanisms may contribute to the decreased risk of vascular dementia.…”