Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study

Abstract

Background: We sought to determine the association between cigarette smoking and carotid plaque ultrasound morphology in a multiethnic cohort. Methods: We analyzed 1,743 stroke-free participants (mean age 65.5 ± 8.9 years; 60% women; 18% white, 63% Hispanic, 19% black; 14% current and 38% former smokers, 48% never smoked) from the Northern Manhattan Study using an ultrasound index of plaque echodensity, the Gray-Scale Median (GSM). Echolucent plaque (low GSM) represents soft plaque and echodense (high GSM) more calcified plaque. The mean GSM weighted by plaque area for each plaque was calculated for those with multiple plaques. Quintiles of GSM were compared to no plaque. Multinomial logistic regression models were used to assess associations of cigarette smoking with GSM, adjusting for demographics and vascular risk factors. Results: Among subjects with carotid plaque (58%), the mean GSM scores for quintiles 1-5 were 48, 72, 90, 105, and 128, respectively. Current smokers had over a two fold increased risk of having GSM in quintile 1 (odds ratio (OR) = 2.17; 95% confidence interval (CI), 1.34-3.52), quintile 2 (OR = 2.33; 95% CI, 1.42-3.83), quintile 4 (OR = 2.05; 95% CI, 1.19-3.51), and quintile 5 (OR = 2.13; 95% CI, 1.27-3.56) but not in quintile 3 (OR = 1.18; 95% CI, 0.67-2.10) as compared to never smokers in fully adjusted models. Former smokers had increased risk in quintile 2 (OR = 1.46; 95% CI, 1.00-2.12), quintile 3 (OR = 1.56; 95% CI, 1.09-2.24), quintile 4 (OR = 1.66; 95% CI, 1.13-2.42), and quintile 5 (OR = 1.73; 95% CI, 1.19-2.51), but not in quintile 1 (OR = 1.05; 95% CI, 0.72-1.55). Conclusions: A nonlinear, V-shaped-like relationship between current cigarette smoking and plaque echodensity was observed. Former smokers were at the highest risk for plaques in high GSM quintiles. Thus, current smokers were more likely to have either soft or calcified plaques and former smokers were at greater risk of having only echodense plaques when compared to those who have never smoked. Further research is needed to determine if plaque morphology mediates an association between smoking and clinical vascular events.

Sex Differences in Prevalence of and Risk Factors for Carotid Plaque among Adults: A Population-based Cross-Sectional Study in Rural China

“…The Northern Manhattan Cohort Study, a population-based cohort study with a unique race/ethnicity profile, reported an overall carotid plaque prevalence of 57% among community-dwelling residents aged ≥39 years26. Similar prevalence rates were reported in other studies, with rates ranging from 47–58%1526272829.…”

“…The Northern Manhattan Cohort Study, a population-based cohort study with a unique race/ethnicity profile, reported an overall carotid plaque prevalence of 57% among community-dwelling residents aged ≥39 years26. Similar prevalence rates were reported in other studies, with rates ranging from 47–58%1526272829. The San Daniele Project, a population-based asymptomatic carotid atherosclerosis study in Italy, reported a lower prevalence rate of carotid plaque (13.3% in men and 13.4% in women) in 199230.…”

“…In contrast to these two studies, we observed a lower prevalence of carotid plaque in a low-income rural population, with a rate of 41.5% overall. Ethnic diversity or socioeconomic status could partly explain these differences, although the mechanisms involved remain to be established2634. Furthermore, variations in the definitions of carotid plaque, study designs, and age structures of the study populations may have contributed to the differences in the reported prevalence rates of carotid plaque.…”

“…High TG was defined as a triglyceride value of ≥2.26 mmol/L. High LDL-C was defined as an LDL-C concentration of ≥4.14 mmol/L, and low HDL-C was defined as an HDL-C concentration of ≤1.04 mmol/L26.…”

Short sleep is associated with more depressive symptoms in a multi-ethnic cohort of older adults

“…Physical activity was categorized as moderate to vigorous physical activity versus none to light [8,19]. Body mass index (BMI) was calculated in kg/m 2 [20] and obesity was defined as ≥30 kg/m 2 . Cardiac disease included a history of angina, myocardial infarction, coronary artery disease, atrial fibrillation, congestive heart failure or valvular heart disease.…”