Association of smoking with coronary artery disease depending on other cardiovascular risk factors

 Aim. To study the possibility of the presence of coronary artery disease (CAD) depending on the smoking status, as well as to estimate the association of smoking with other traditional risk factors in residents of Kemerovo region aged 25–64 years.

Materials and methods. We analyzed the results of the multicenter epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation” in Kemerovo region obtained from a random sample of 1,599 subjects aged 25–64 years. Besides the smoking status, the following parameters were analyzed: gender, age, education, diabetes mellitus (DM) and arterial hypertension (AH) history, hypercholesterolemia, hypertriglyceridemia, high level of low-density lipoproteins, low level of high-density lipoproteins (HDL), hyperglycemia, obesity, alcohol abuse, and depression.

Results. Three groups were formed depending on the smoking status: group 1 included 484 (30.3%) current smokers, group 2 had 317 (19.8%) former smokers and group 3 had 798 (49.9%) individuals who had never smoked. The groups did not differ in the prevalence of CAD. When determining the rank significance of the impact of risk factors on the possibility of CAD development in the overall population, it was revealed that the age affected the risk of CAD the most, while smoking and low HDL had minimal impact.  The impact of the smoking factor on CAD was higher in the representatives of the older age group; however, even in the subjects aged ≥ 50 years,
the smoking factor was not the leading one and followed DM,  hypertriglyceridemia, depression, and obesity. The possibility of CAD development in smokers, as opposed to individuals who had never smoked, increased when smoking was accompanied by hypercholesterolemia, hypertriglyceridemia, male sex, lack of higher education, depression, and age of ≥ 50 years. The possibility of CAD development in former smokers as opposed to nonsmokers increased when smoking was accompanied by hyperglycemia.

Conclusion. Smoking is not the primary risk factor in CAD detection in the studied sample. In the presence of additional risk factors, the impact of smoking on the possibility of CAD detection increases.  

1. Баланова Ю.А., Концевая А.В., Шальнова С.А., Деев А.Д., Артамонова Г.В., Гатагонова Т.М., Дупляков Д.В., Ефанов А.Ю., Жернакова Ю.В., Ильин В.А., Конради А.О., Либис Р.А., Минаков А.В., Недогода С.В., Оганов Р.Г., Ощепкова Е.В., Романчук С.В., Ротарь О.П., Трубачева И.А., Шляхто Е.В., Бойцов С.А., Муромцева Г.А., Евстифеева С.Е., Капустина А.В., Константинов В.В., Мамедов М.Н., Баранова Е.И., Назарова О.А., Шутемова Е.А., Фурменко Г.И., Бабенко Н.И., Азарин О.Г., Бондарцов Л.В., Хвостикова А.Е., Ледяева А.А., Чумачек Е.В., Исаева Е.Н., Басырова И.Р., Кондратенко В.Ю., Лопина Е.А., Сафонова Д.В., Скрипченко А.Е., Индукаева Е.В., Черкасс Н.В., Максимов С.А., Данильченко Я.В., Мулерова Т.А., Шалаев С.В., Медведева И.В., Шава В.П., Сторожок М.А., Толпаров Г.В., Астахова З.Т., Тогузова З.А., Кавешников В.С., Карпов Р.С., Серебрякова В.Н. Распространенность поведенческих факторов риска сердечно-сосудистых заболеваний в российской популяции по результатам исследования ЭССЕ-РФ. Профилактическая медицина. 2014; 17 (5): 42–52.

2. Самородская И.В., Баздырев Е.Д., Барбараш О.Л. «Парадокс» факторов риска развития сердечно- сосудистых заболеваний. Фокус на курение. Комплексные проблемы сердечно-сосудистых заболеваний. 2019; 8 (1): 90–99. DOI: 10.17802/2306-1278-2019-8-1-90-99.

3. Liu C.C., Yeh H.I. Nicotine: a double-edged sword in atherosclerotic disease. Acta Cardiol. Sin. 2014; 30 (2): 108–113.

4. Бойцов С.А., Погосова Н.В., Бубнова М.Г., Драпкина О.М., Гаврилова Н.Е., Еганян Р.А., Калинина А.М., Карамнова Н.С., Кобалава Ж.Д., Концевая А.В., Кухарчук В.В., Лукьянов М.М., Масленникова Г.Я., Марцевич С.Ю., Метельская В.А., Мешков А.Н., Оганов Р.Г., Попович М.В., Соколова О.Ю., Сухарева О.Ю., Ткачева О.Н., Шальнова С.А., Шестакова М.В., Юферева Ю.М., Явелов И.С. Кардиоваскулярная профилактика 2017. Российские национальные рекомендации. Российский кардиологический журнал. 2018; 23 (6): 7–122. DOI: 10.15829/1560-4071-2018-6-7-122.

5. Van Sloten T.T., Tafflet M., Périer M.C., Dugravot A., Climie R.E.D., Singh-Manoux A., Empana J.P. Association of change in cardiovascular risk factors with incident cardiovascular events. JAMA. 2018; 320 (17): 1793–1804. DOI: 10.1001/jama.2018.16975.

6. Liu H., Deng X., Peng Y., Zeng Q., Song Z., He W., Zhang L., Gao G., Xiao T., Yu X. Meta-analysis of serum non-high-density lipoprotein cholesterol and risk of coronary heart disease in the general population. Clin. Chim. Acta. 2017; 471: 23–28. DOI: 10.1016/j.cca.2017.05.006.

7. Khandaker G.M., Zuber V., Rees J.M.B., Carvalho L., Mason A.M., Foley C.N., Gkatzionis A., Jones P.B., Burgess S. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population- based cohort. Int. J. Cardiol. 2018; 271: 8–12. DOI: 10.1038/s41380-019-0395-3.

8. O’Neil A., Fisher A.J., Kibbey K.J., Jacka F.N., Kotowicz M.A., Williams L.J., Stuart A.L., Berk M., Lewandowski P.A., Taylor C.B., Pasco J.A. Depression is risk factor for incident coronary heart disease in women: An 18-year longitudinal study. J. Affect Disord. 2016; 196: 117–124. DOI: 10.1016/j.jad.2016.02.029.

9. Ariyo A.A., Haan M., Tangen C.M., Rutledge J.C., Cushman M., Dobs A., Furberg C.D. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Circulation. 2000; 102 (15): 1773–1779. DOI: 10.1161/01.cir.102.15.1773.

10. Elderon L., Whooley M.A. Depression and cardiovascular disease. Prog. Cardiovasc. Dis. 2013; 55 (6): 511–523. DOI: 10.1016/j.pcad.2013.03.010.

11. Wilson P.W., Cupples L.A., Kannel W.B. Is hyperglycemia associated with cardio-vascular disease? The Framingham Study. Am. Heart. J. 1991; 121 (2): 586–590. DOI: 10.1016/0002-8703(91)90729-2.

12. Ahn S.V., Kim H.C., Nam C.M., Suh I. Sex difference in the effect of the fasting serum glucose level on the risk of coronary heart disease. J. Cardiol. 2018; 71 (2): 149–154. DOI: 10.1016/j.jjcc.2017.07.013.

13. Xia J., Yin C. Glucose variability and coronary artery disease. Heart Lung Circ. 2019; 28 (4): 553–559. DOI: 10.1016/j.hlc.2018.10.019.

14. Škrha J., Šoupal J., Škrha J., Prázný M. Glucose variability, HbA1c and microvascular complications. Rev. Endocr. MeБаздырев Е.Д., Максимов С.А., Галимова Н.А. и др. Связь курения с ишемической болезнью сердца Bulletin of Siberian Medicine. 2021; 20 (1): 7–15 tab. Disord. 2016; 17 (1): 103–110. DOI: 10.1007/s11154-016-9347-2.

15. Schiattarella G.G., Carrizzo A., Ilardi F., Damato A., Ambrosio M., Madonna M., Trimarco V., Marino M., De Angelis E., Settembrini S., Perrino C., Trimarco B., Esposito G., Vecchione C. Rac1 modulates endothelial function and platelet aggregation in diabetes mellitus. J. Am. Heart Assoc. Cardiovasc. Cerebrovasc. Dis. 2018; 7 (8): e007322. DOI: 10.1161/JAHA.117.007322.

16. Wu N., Shen H., Liu H., Wang Y., Bai Y., Han P. Acute blood glucose fluctuation enhances rat aorta endothelial cell apoptosis, oxidative stress and pro-inflammatory cytokine expression in vivo. Cardiovasc. Diabetol. 2016; 15: 109. DOI: 10.1186/s12933-016-0427-0.