Coronary Atherosclerotic Plaque Volume Quantified by Computed Tomographic Angiography in Smokers Compared to Nonsmokers

Rationale and Objectives: We sought to compare the prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque in patients with smokers versus nonsmokers. Materials and Methods: We studied consecutive patients suspected of coronary artery disease and who underwent coronary computed tomography angiography. A structured interview and review of existing clinical data was conducted before computed tomography angiography to collect information on demographic characteristics, the presence of cardiovascular risk factors. The volume of lipid, fibrous, and calcified plaque were automatically calculated and marked in different colors according to predefined Hounsfield unit thresholds. The prevalence and volume of plaques were compared between smokers and nonsmokers. Results: Overall 6380 patients (3351 men and 3029 women, mean age 55.35 years) were finally analyzed, of whom 2075 (32.5%) were smokers, and 4305 (67.5%) were never smokers. The prevalence of any plaque in smokers was significantly higher compared to never smokers (47.7% vs. 32.3%, p < 0.001). Smoking was an independent risk factor of the presence of any plaque after correcting for age, gender, body mass index, hypertension, dyslipidemia, diabetes, and family history in a multivariate model (odds ratio = 1.250 (1.088-1.437), p = 0.002). The volume of lipid plaque, fibrous plaque, calcified plaque, and total plaque in smokers was significantly greater than nonsmokers (p < 0.001). Conclusion: The prevalence and volume of lipid plaque, fibrous plaque, and calcified plaque were significantly higher in smokers versus never smokers.