Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery

Axel Dahlgren; David Erlinge; Ryo Torii; Enhui Yong; Göran Bergström; Tomas Jernberg; Ole Fröbert; Pernille G. Thrane; Michael Mæng; Gregg W. Stone; Moman A. Mohammad

doi:10.1016/j.jscai.2025.103609

Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery

Axel Dahlgren, David Erlinge^*, Ryo Torii, Enhui Yong, Göran Bergström, Tomas Jernberg, Ole Fröbert, Pernille G. Thrane, Michael Mæng, Gregg W. Stone, Moman A. Mohammad

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95% CI, 10.9-11.7) for smokers, 10.2 (95% CI, 9.9-10.5) for former smokers, and 7.7 (95% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4%; LAD, 42.0%; LCX, 15.6%; nonsmokers: RCA, 33.1%; LAD, 51.4%; LCX, 15.5%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.

Original language	English
Article number	103609
Journal	Journal of the Society for Cardiovascular Angiography and Interventions
Number of pages	9
ISSN	2772-9303
DOIs	https://doi.org/10.1016/j.jscai.2025.103609
Publication status	E-pub / Early view - 13 May 2025

Keywords

coronary artery atherosclerosis
natural progression
smoking

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Dahlgren, A., Erlinge, D., Torii, R., Yong, E., Bergström, G., Jernberg, T., Fröbert, O., Thrane, P. G., Mæng, M., Stone, G. W., & Mohammad, M. A. (2025). Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery. Journal of the Society for Cardiovascular Angiography and Interventions, Article 103609. Advance online publication. https://doi.org/10.1016/j.jscai.2025.103609

@article{f26e784a0ec740e9b57367c89cf3d4db,

title = "Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery",

abstract = "Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95\% CI, 10.9-11.7) for smokers, 10.2 (95\% CI, 9.9-10.5) for former smokers, and 7.7 (95\% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95\% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95\% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4\%; LAD, 42.0\%; LCX, 15.6\%; nonsmokers: RCA, 33.1\%; LAD, 51.4\%; LCX, 15.5\%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.",

keywords = "coronary artery atherosclerosis, natural progression, smoking",

author = "Axel Dahlgren and David Erlinge and Ryo Torii and Enhui Yong and G{\"o}ran Bergstr{\"o}m and Tomas Jernberg and Ole Fr{\"o}bert and Thrane, \{Pernille G.\} and Michael M{\ae}ng and Stone, \{Gregg W.\} and Mohammad, \{Moman A.\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = may,

day = "13",

doi = "10.1016/j.jscai.2025.103609",

language = "English",

journal = "Journal of the Society for Cardiovascular Angiography and Interventions",

issn = "2772-9303",

publisher = "Elsevier B.V.",

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Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery. / Dahlgren, Axel; Erlinge, David; Torii, Ryo et al.
In: Journal of the Society for Cardiovascular Angiography and Interventions, 13.05.2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Smoking and Coronary Atherosclerosis

T2 - Disproportionate Impact on the Right Coronary Artery

AU - Dahlgren, Axel

AU - Erlinge, David

AU - Torii, Ryo

AU - Yong, Enhui

AU - Bergström, Göran

AU - Jernberg, Tomas

AU - Fröbert, Ole

AU - Thrane, Pernille G.

AU - Mæng, Michael

AU - Stone, Gregg W.

AU - Mohammad, Moman A.

PY - 2025/5/13

Y1 - 2025/5/13

N2 - Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95% CI, 10.9-11.7) for smokers, 10.2 (95% CI, 9.9-10.5) for former smokers, and 7.7 (95% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4%; LAD, 42.0%; LCX, 15.6%; nonsmokers: RCA, 33.1%; LAD, 51.4%; LCX, 15.5%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.

AB - Background: We aimed to study the long-term effect of smoking on coronary atherosclerosis progression at the segmental level. Methods: Angiographic data (1989-2017) on current, former, and nonsmokers were collected from the Swedish Coronary Angiography and Angioplasty Registry. The Western Denmark Heart Registry was used to validate the results. Patients with clinically indicated angiography with ≥2 coronary arteries without obstructive coronary artery disease were included. The main outcome was segmental plaque progression, percutaneous coronary intervention, or coronary artery bypass grafting within 15 years. Results: In total, 215,364 Swedish patients with 993,405 coronary arteries (left anterior descending artery [LAD], left circumflex artery [LCX], and right coronary artery [RCA]) were included. The validation cohort consisted of 19,613 patients. Per 1000 patient-years, plaque progression incidence rate was 11.3 (95% CI, 10.9-11.7) for smokers, 10.2 (95% CI, 9.9-10.5) for former smokers, and 7.7 (95% CI, 7.5-7.9) for nonsmokers. Smokers demonstrated higher relative risk of plaque progression in RCA (hazard ratio, 1.87; 95% CI, 1.73-2.03) vs LAD (hazard ratio, 1.21; 95% CI, 1.12-1.30). Swedish and Danish smokers with ST-segment elevation myocardial infarction had higher proportion of RCA as the culprit artery compared to nonsmokers (smokers: RCA, 42.4%; LAD, 42.0%; LCX, 15.6%; nonsmokers: RCA, 33.1%; LAD, 51.4%; LCX, 15.5%). Conclusions: This observational cohort study identifies distinct differences in plaque progression patterns between smokers and nonsmokers, with smoking linked to increased plaque progression in the RCA, in contrast to the LAD in nonsmokers. These findings reemphasize the need for targeted smoking prevention and warrant further investigation into RCA-specific mechanisms of plaque progression and MI.

KW - coronary artery atherosclerosis

KW - natural progression

KW - smoking

UR - http://www.scopus.com/inward/record.url?scp=105005002127&partnerID=8YFLogxK

U2 - 10.1016/j.jscai.2025.103609

DO - 10.1016/j.jscai.2025.103609

M3 - Journal article

AN - SCOPUS:105005002127

SN - 2772-9303

JO - Journal of the Society for Cardiovascular Angiography and Interventions

JF - Journal of the Society for Cardiovascular Angiography and Interventions

M1 - 103609

ER -

Smoking and Coronary Atherosclerosis: Disproportionate Impact on the Right Coronary Artery

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