Highlights
- •CTC provokes a higher risk of atheromatosis in femoral arteries than in carotids.
- •CTC had a dose-dependent effect on atheromatosis burden similar in both sexes.
- •Addition of CTC to the SCORE2 model improved severe atheromatosis (SA) prediction.
- •Age and CTC were the most important clinical predictors of SA in both sexes.
Abstract
Background and aims
Sex-specific impact of cumulative tobacco consumption (CTC) on atheromatosis extension
and total plaque area remains unknown. We aimed to determine the impact of CTC in
atheromatosis localization and burden.
Methods
We performed a cross-sectional analysis in 8330 asymptomatic middle-aged individuals.
12-territory vascular ultrasounds in carotid and femoral arteries were performed to
detect atheromatous plaque presence and to measure total plaque area. Adjusted regressions
and conditional predictions by smoking habit or CTC (stratified in terciles as low
(≤13.53), medium (13.54–29.3), and high (>29.3 packs-year)) were calculated. Severe
atheromatosis (SA, ≥3 territories with atheroma plaque) was predicted with the Systematic
COronary Risk Evaluation 2 (SCORE2) model. The improvement of SA prediction after
adding CTC was evaluated.
Results
CTC was associated with an increased risk of atheromatosis, stronger in femoral than
in carotid artery, but similar in both sexes. A dose-dependent effect of CTC on the
number of territories with atheroma plaque and total plaque area was observed. Addition
of CTC to the SCORE2 showed a higher sensitivity, accuracy, and negative predictive
value in males, and a higher specificity and positive predictive value in females.
In both sexes, the new SCORE2-CTC model showed a significant increase in AUC (males:
0.033, females: 0.038), and in the integrated discrimination index (males: 0.072;
females: 0.058, p < 0.001). Age and CTC were the most important clinical predictors of SA in both sexes.
Conclusions
CTC shows a dose-dependent association with atheromatosis burden, impacts more strongly
in femoral arteries, and improves SA prediction.
Clinicaltrials.gov
: NCT03228459.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Accepted:
May 1,
2023
Received in revised form:
April 26,
2023
Received:
September 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier B.V.
