Elsevier

Atherosclerosis

Volume 230, Issue 2, October 2013, Pages 304-309
Atherosclerosis

Atherogenesis in youth – Early consequence of adolescent smoking

https://doi.org/10.1016/j.atherosclerosis.2013.08.004Get rights and content

Highlights

  • Atherogenesis begins in childhood.

  • We investigated the impact of smoking on Carotid Intima Media thickness (CIMT) in healthy adolescents.

  • Smoking, self-reported and objectively assessed, is associated with a significant increase in CIMT.

  • The smoking impact is independent of other known risk factors (BMI, Blood lipids etc) and parental smoking.

Abstract

Background

Cigarette smoking is a prevalent risk behavior among adolescents and tracks into adulthood. Little is known on the early impact of smoking on the vasculature in adolescence, although smoking is considered highly atherogenic in adults. We investigated the association between active smoking and Carotid artery Intima Media Thickness (CIMT), an early indicator of atherosclerosis.

Methods and results

The SAPALDIA Youth Study is a nested study involving 356 offspring (8–20 yrs) of the Swiss SAPALDIA cohort who reported on early life, health and lifestyle, smoking habits and disease history. 288 youth underwent clinical examination. Mean average and maximum CIMT were calculated across all images of right and left common carotid. Multi-level linear regression was performed with weekly smoking, daily number of cigarettes and serum cotinine, adjusting for participant's and parental confounders. Valid CIMT data was available in 275 offspring (mean age 15 yrs, 53% girls). Weekly smoking was reported by 10% and current parental smoking by 24%. Individual mean and maximal CIMT averaged to 0.52 mm (sd 0.05) and 0.60 mm (sd. 0.05), respectively. Regression analyses yielded significant increase in average CIMT (mm) in weekly smokers (0.025, 95% CI 0.006; 0.045), per cigarette/day (0.003, 95% CI 0.001; 0.005) and serum cotinine level (0.008/100 μg/l, 95% CI 0.002; 0.015), which remained consistent after adjusting for parental confounders.

Conclusion

Our study yields evidence of an early adverse impact of active tobacco exposure on atherogenesis in adolescents, independent of parental smoking, underlining the public health importance of prevention of adolescent smoking.

Introduction

Despite all efforts to reduce smoking in young adults on a global scale cigarette smoking remains a prevalent risk behavior in adolescents [1]. Smoking in youth tracks into adulthood and early nicotine addiction reduces the chances of smoking cessation in adulthood. In view of the high relevance of smoking for cardiovascular diseases later in life, the early uptake of this habit is a concern. Atherosclerosis, the key cause of cardiovascular diseases, originates in childhood. The association between cardiovascular risk factors in childhood, such as obesity, diabetes or hyperlipidemia, and atherosclerotic disease in adulthood has been shown convincingly in cohort studies [2], [3], and, remarkably, have been associated with arterial changes already in childhood [4], [5], [6], [7], [8], [9]. Active as well as passive smoking has been associated with an increase of inflammation, oxidative stress, platelet activation, and endothelial dysfunction [10] – all potential mechanisms in the development of atherosclerosis. Postmortem studies found arterial wall pathologies in infancy and adolescence [11], [12] and first evidenced an atherogenic effect of tobacco smoke in youth [13]. Other studies have addressed the impact of parental smoking on arterial changes in childhood [14], [15], [16], [17], [18], [19]. To our knowledge, the association of active smoking with CIMT in adolescence has not been well investigated.

The SAPALDIA Youth Study collected and measured classical cardiovascular risk factors and CIMT along with the SAPALDIA adult cohort study in 2010 and 2011. The present study investigated the impact of active smoking exposure on early atherogenesis in youth.

Section snippets

Methods

The SAPALDIA Youth Study is a cross-sectional study nested into the Swiss Study on Air Pollution And Lung and Heart Disease In Adults (SAPALDIA) [20], a cohort recruited and assessed in 1991 and followed up twice since, in 2001 and 2010/11. In the second follow-up, the four Swiss-German speaking centers participated in the SAPALDIA Youth Study. Offspring of adult SAPALDIA participants born between the first and second survey (N = 530) were asked to participate in the study. If more than one

Results

The mean age of the study sample was 15 years (interquartile range 12–18 years); 53% youth were female. The lifetime prevalence of smoking was 32%. Ten percent reported smoking at least once a week and additional four percent smoked at least once a month. Weekly smokers were older (mean age 18 yrs) and reported higher puberty levels than non-smoking younger participants (Table 1). A quarter of the offspring reported current parental smoking (24%), but less than half of the parents smoked

Discussion

Despite the young age of our study population and consequently a short smoking history we observed thicker carotid artery walls among currently smoking adolescents. These results were robust in different models using various measures of smoking and adjusting for parental confounders, most importantly parental smoking and cardiovascular risk factors. To our knowledge this study is the first to investigate active smoking and CIMT in a healthy adolescent population.

Smoking in adolescence continues

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