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Smoking and Coronary Atherosclerosis : Disproportionate Impact on the Right Coronary Artery

Dahlgren, Axel LU orcid ; Erlinge, David LU orcid ; Torii, Ryo ; Yong, Enhui ; Bergström, Göran ; Jernberg, Tomas ; Fröbert, Ole ; Thrane, Pernille G. ; Mæng, Michael and Stone, Gregg W. , et al. (2025) In Journal of the Society for Cardiovascular Angiography and Interventions 4(8).
Abstract

Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left... (More)

Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95% CI, 10.9-11.7) for smokers, 10.2 (95% CI, 9.9-10.5) for former smokers, and 7.7 (95% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4%; LAD, 42.0%; LCX, 15.6%; nonsmokers: RCA, 33.1%; LAD, 51.4%; LCX, 15.5%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
coronary artery atherosclerosis, natural progression, smoking
in
Journal of the Society for Cardiovascular Angiography and Interventions
volume
4
issue
8
article number
103609
publisher
Elsevier
external identifiers
  • scopus:105005002127
ISSN
2772-9303
DOI
10.1016/j.jscai.2025.103609
language
English
LU publication?
yes
id
a78e12f4-49e0-4edc-90de-1374c0f8a390
date added to LUP
2025-09-26 13:38:27
date last changed
2025-10-14 10:15:40
@article{a78e12f4-49e0-4edc-90de-1374c0f8a390,
  abstract     = {{<p>Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95% CI, 10.9-11.7) for smokers, 10.2 (95% CI, 9.9-10.5) for former smokers, and 7.7 (95% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4%; LAD, 42.0%; LCX, 15.6%; nonsmokers: RCA, 33.1%; LAD, 51.4%; LCX, 15.5%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.</p>}},
  author       = {{Dahlgren, Axel and Erlinge, David and Torii, Ryo and Yong, Enhui and Bergström, Göran and Jernberg, Tomas and Fröbert, Ole and Thrane, Pernille G. and Mæng, Michael and Stone, Gregg W. and Mohammad, Moman A.}},
  issn         = {{2772-9303}},
  keywords     = {{coronary artery atherosclerosis; natural progression; smoking}},
  language     = {{eng}},
  number       = {{8}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the Society for Cardiovascular Angiography and Interventions}},
  title        = {{Smoking and Coronary Atherosclerosis : Disproportionate Impact on the Right Coronary Artery}},
  url          = {{http://dx.doi.org/10.1016/j.jscai.2025.103609}},
  doi          = {{10.1016/j.jscai.2025.103609}},
  volume       = {{4}},
  year         = {{2025}},
}