Mediating effects of lipids on the association between smoking and coronary artery disease risk among Chinese

Abstract

Objective: The mechanism between smoking and coronary artery disease (CAD) remains unclear. It is likely that lipid (including triglycerides (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C)) have been functioning as one of the mediators between smoking and the CAD occurrence. The study aimed to investigate the mediating effect of lipid on the relationship between smoking and CAD risk. Methods: The case-control study included 2048 subjects. General linear regression analysis was used to corroborate the association between smoking and lipid levels. Univariate and multivariate logistic regression analysis were performed to reveal the relationship between smoking, lipid and the risk of CAD. Mediation analysis was used to investigate whether the association between smoking and CAD risk was mediated by lipid. Results: Smoking was found to be associated with the risk of CAD (odds ratio (OR) = 1.34, 95% confidence interval (CI): 1.05-1.71, P = 0.019). Regression analysis showed that TG, TC and HDL-C were associated with CAD (OR = 2.69, 95%CI: 2.12-3.40, P < 0.001; OR = 0.34, 95%CI: 0.29-0.43, P < 0.001; OR = 0.37, 95%CI: 0.30-0.47, P < 0.001). Moreover, the ratio of TG to HDL-C (TG/HDL-C) was also related to CAD (OR = 4.45, 95%CI: 3.52-5.64, P < 0.001). Mediation analysis showed that among the effects of smoking on CAD, 17.52% was mediated by lipid, in which HDL-C accounted for 11.16% and TG accounted for 6.36%. Further analysis showed that the effect was also partially mediated by TG/HDL-C, which was accounted for 28%. Conclusions: Lipid plays a partial mediation on the association between smoking and CAD risk. The study provides a clue on the mediation effect of lipids on the relationship between smoking and CAD risks, which is a novel insight to the progression of CAD.

The role of traditional obesity parameters in predicting the number of stenosed coronary arteries (≥ 60%) among patients undergoing cardiac catheterization

“…In the present study, smoking was found to be significantly associated with higher numbers of stented coronary arteries and severe stenosed coronary arteries (≥ 60%), which comes consistent with the studies of Song et al 28 , Bouabdallaoui et al 29 , and Chen et al 30 . These studies attributed this finding to the fact that smoking may increase oxidative stress, which is considered a precursor for atherosclerosis.…”

Use of lipid parameters to identify apparently healthy men at high risk of arterial stiffness progression

“…But we showed that baseline TG and TG/HDL-C were able to predict arterial stiffness progression even after simultaneous adjustment for smoking and other risk factors. Interestingly, studies on the role of lipids in the association between smoking and CVD have been published but far from a convincing conclusion [46][47][48].…”

Smoking and Hypertriglyceridemia Predict ST-Segment Elevation Myocardial Infarction in Kosovo Patients with Acute Myocardial Infarction

“…On the other hand, hypertriglyceridemia is conventionally considered a weaker risk factor for atherosclerosis compared to raised LDL-cholesterol [ 30 ]. Consequently, the accumulative impact of smoking, together with dyslipidemia, has been proven to be a nasty risk factor for coronary artery events [ 31 , 32 ] and stroke. Separating those risk factors individually as predictors of coronary events is not always easy; however, to identify the exact pattern of acute coronary artery disease and its related risk factors, we conducted our analysis in such a manner.…”