Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease

Christopher Bullen


Expert Rev Cardiovasc Ther. 2008;6(6):883-895. 

In This Article

Abdominal Aortic Aneurysm

Smoking is the most important modifiable risk factor for development of abdominal aortic aneurysm (AAA) and not only leads to progression of aortic atherosclerosis, but also increases the risk of AAA formation[31] and expansion.[32] Reported RRs of AAA associated with cigarette smoking in the literature range from 2 to 9 and a dose–response association has been found. For example, in a UK study of 5356 men and women followed between 1988 and 1995, the level of risk for AAA increased with the number of cigarettes smoked daily.[33] In a systematic review, Lederle et al. noted that in men the association of current smoking with AAA was 2.5-times greater than the association with coronary artery disease and 3.5-times greater than with cerebrovascular disease.[34] In the largest cohort study of AAA to date, more than 100,000 people were followed for a median of 13 years and up to 33 years for the outcome of incident – clinically apparent AAA.[35] Cigarette smoking of three or more packs per day was the strongest risk factor for incident AAA in this cohort (RR: 6.6), followed by age 65 years or older (RR: 6). The results confirmed the previously reported associations with smoking and showed a dose–response association with adjusted RRs of 3, 5 and 7 for current smokers of less than one pack per day, between one and two packs per day, and of three or more packs per day, respectively.[35]


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