Smoking, lipoproteins and coronary heart disease risk: Data from the Munster Heart Study (PROCAM)

Aims The mechanism of the increase in coronary heart disease riskassociated with smoking is unclear, but may partly be due tosmoking-related changes in intermediate risk factors such aslipid levels, fibrinogen and blood pressure. We therefore examinedthe distribution of these variables among smokers and non-smokersin the Münster Heart Study. Methods 20696 men, aged 41·7±2·7 years (mean±SD)and 10212 women, aged 37·0±2·6 years, wereenrolled between 1978 and 1995. Thirty-two percent of womenand 36% of men smoked. Compared to non-smokers, mean levelsof low density lipoprotein cholesterol, total cholesterol, triglyceridesand fibrinogen were increased, respectively, by 1·4%,0·9%, 15% and 12·1% in male and by 2·0%,5·5%, 12% and 3·4% in female smokers. Mean highdensity lipoprotein cholesterol levels, body mass index andblood pressure were reduced, respectively, by 6·4%, 3·8%,and 2% in male, and by 6·7% 1·2% and 2% in femalesmokers. In the subgroup of 4639 men aged 40 to 65 with 8 yearsof follow-up, the coronary event rate (definite myocardial infarction,sudden cardiac death) in cigarette smokers was more than twicethat of non-smokers with otherwise identical risk factors. Conclusion In the Münster Heart Study, smoking was associated withadverse changes in lipids (of greater magnitude in women), andfibrinogen (of greater magnitude in men). However, these changesexplained only a small part of the smoking-related increasein coronary heart disease risk.The European Society of Cardiology