Cigarette smoking and aortic calcification: meta-analysis and systematic review

Cigarette smoking has been proposed to contribute to aortic stiffness and aortic calcification (AC), although evidence remains inconsistent across populations, anatomical segments, and imaging modalities. We conducted a meta-analysis to clarify the association between current smoking and AC and to examine effect modifiers like as age, sex, and aortic segment.

We conducted a systematic database search from data inception to mid-November 2025. We used random-effects models to estimate the pooled prevalence of AC among current smokers and pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for the association between current smoking and AC.

Twelve studies involving 147,972 participants, including 49,329 current smokers, met the inclusion criteria. Most studies were community-based, used computed tomography (CT) imaging, and assessed thoracic or abdominal AC. Current smoking showed a nonsignificant trend toward higher odds of overall AC (random-effects OR= 1.27, 95% CI: 0.98-1.65; P = 0.075). The random-effects model indicated that 37.8% of smokers had detectable AC. Subgroup analyses showed borderline associations in adults aged ≥60 years (OR, 1.48, P = 0.051). No statistically significant association was observed in males (OR, 1.23 CI, 0.85-1.77, P = 0.267), and significant association in CT-based studies (OR, 1.44 CI, 1.04-1.98, P = 0.028). Segment-specific analyses demonstrated a significant association with abdominal AC and a borderline association with thoracic AC.

Current cigarette smoking was not significantly associated with overall aortic calcification. However, exploratory subgroup analyses identified significant associations with abdominal and CT-detected aortic calcification, warranting confirmation in prospective studies.