Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study

Dixon Yang, Sunil Iyer, Hannah Gardener, David Della Morte, Milita Crisby, Chuanhui Dong, Ken Cheung, Consuelo Mora-McLaughlin, Clinton B Wright, Mitchell S. Elkind, Ralph L Sacco, Tatjana Rundek

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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.

Original languageEnglish (US)
Pages (from-to)136-143
Number of pages8
JournalCerebrovascular Diseases
DOIs
StateAccepted/In press - Jul 25 2015

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Smoking
Odds Ratio
Confidence Intervals
Logistic Models
Hispanic Americans
Blood Vessels
Stroke
Demography
Research

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study. / Yang, Dixon; Iyer, Sunil; Gardener, Hannah; Della Morte, David; Crisby, Milita; Dong, Chuanhui; Cheung, Ken; Mora-McLaughlin, Consuelo; Wright, Clinton B; Elkind, Mitchell S.; Sacco, Ralph L; Rundek, Tatjana.

In: Cerebrovascular Diseases, 25.07.2015, p. 136-143.

Research output: Contribution to journalArticle

Yang, Dixon ; Iyer, Sunil ; Gardener, Hannah ; Della Morte, David ; Crisby, Milita ; Dong, Chuanhui ; Cheung, Ken ; Mora-McLaughlin, Consuelo ; Wright, Clinton B ; Elkind, Mitchell S. ; Sacco, Ralph L ; Rundek, Tatjana. / Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study. In: Cerebrovascular Diseases. 2015 ; pp. 136-143.
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title = "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.",
author = "Dixon Yang and Sunil Iyer and Hannah Gardener and {Della Morte}, David and Milita Crisby and Chuanhui Dong and Ken Cheung and Consuelo Mora-McLaughlin and Wright, {Clinton B} and Elkind, {Mitchell S.} and Sacco, {Ralph L} and Tatjana Rundek",
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T1 - Cigarette Smoking and Carotid Plaque Echodensity in the Northern Manhattan Study

AU - Yang, Dixon

AU - Iyer, Sunil

AU - Gardener, Hannah

AU - Della Morte, David

AU - Crisby, Milita

AU - Dong, Chuanhui

AU - Cheung, Ken

AU - Mora-McLaughlin, Consuelo

AU - Wright, Clinton B

AU - Elkind, Mitchell S.

AU - Sacco, Ralph L

AU - Rundek, Tatjana

PY - 2015/7/25

Y1 - 2015/7/25

N2 - 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.

AB - 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.

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