Cross-sectional and longitudinal associations of smoking behavior with central arterial hemodynamic measures: The Framingham Heart Study

Abstract Background Cigarette smoking is a leading modifiable cardiovascular disease risk factor. Cross-sectional studies demonstrated variable relations of smoking behavior with measures of vascular function. Additionally, the impact of persistent versus changes in smoking behaviors on alterations in central arterial function is unclear. Methods and Results We assessed associations of smoking behavior and intensity with measures of central arterial hemodynamics in 6597 participants (51.5% never smoked, 34.8% formerly quit, 4.3% recent quit, and 9.3% currently smoking) of the Framingham Heart Study (N=3606 [55%] women). In cross-sectional models, central vascular measures were different across categories of smoking behavior. For example, augmentation index was higher among participants who formerly quit smoking (least squares mean±standard error=14.1±0.4%; P <0.001) and were currently smoking (18.1±0.5%; P <0.001) compared to participants who never smoked (12.6±0.3%). Among participants who were currently smoking, higher cigarettes per day (estimated B =1.41; 95% CI, 0.47—2.34; P =0.003) was associated with higher augmentation index. Among participants who had quit smoking, higher pack-years was associated with higher augmentation index (est. B =0.85; 95% CI, 0.60—1.14) and central pulse pressure (est. B =0.84; 95% CI, 0.46—1.21). Using restricted cubic splines, we observed a negative linear association for augmentation index, but a distinct nonlinear association for characteristic impedance and central pulse pressure, with higher time since quit (all P <0.001). In longitudinal models, we observed higher increases in augmentation index among participants who persistently quit (4.62±0.41%; P <0.001) and persistently smoked (5.48±0.70%; P =0.002) compared to participants who persistently never smoked (3.45±0.37%). Conclusion Central arterial measures are sensitive to smoking status and intensity and changes in smoking behavior. Longer smoking cessation may partially revert central arterial measures to levels comparable to those with lower smoking exposure.