The role of cigarette smoking in atherosclerotic disease: an epidemiologic analysis

The Bowling Green Study of the Primary and Secondary Prevention of Atherosclerotic Disease has accumulated an age-sex register of 668 consecutive patients who developed some form of atherosclerotic disease between 4 November 1974 and 1 January 1997. Observational data relating to levels of lipids and glucose, blood pressure, body-mass index, and cigarette-smoking status are included in the age-sex register. Analysis of this database clearly shows that cigarette smoking is the main cause of atherosclerotic disease, including events in each of the vascular trees, as well as multiple-system disease and death, at ages much earlier than the ages at which similar atherosclerotic events occur in ex-smokers. Ex-smokers, in turn, suffer corresponding events at earlier ages than do never-smokers. Cigarette smoking produces atherosclerotic events at roughly the same age irrespective of status of other risk factors and is therefore the single most important risk factor for atherosclerosis.