Smoking intensity and lipoprotein abnormalities in active smokers

BackgroundSmoking is associated with decreased high-density lipoprotein cholesterol (HDL-C) and increased levels of triglycerides.ObjectiveWe sought to evaluate the effects of five markers of smoking intensity on lipoprotein concentrations and particle sizes in a large, modern cohort of current smokers.MethodsFasting nuclear magnetic resonance spectroscopy lipoprotein profiles were obtained in a large cohort of current smokers enrolled in a smoking-cessation trial. Multivariate linear regression models were constructed to determine predictors of lipoprotein fractions. Models included age, sex, race, waist circumference, level of physical activity, and alcohol consumption. Smoking intensity parameters included current cigarettes smoked/day, pack-years, the Fagerström Test of Nicotine Dependence score, and carbon monoxide (CO) levels.ResultsThe 1504 subjects (58% women, 84% white) had a mean (standard deviation) age of 45 (11.0) years. They smoked 21.4 (8.9) cigarettes/day (29.4 [20.4] pack-years). HDL-C (42.0 [13.5] mg/dL) and total HDL particles (30.3 [5.9] μmol/L) were low. Cigarettes smoked/day independently predicted greater total cholesterol (P = .009), low-density lipoprotein cholesterol (P = .023), and triglycerides (P = .002). CO levels predicted lower HDL-C (P = .027) and total HDL particles (P = .009). However, the incremental R2 for each marker of smoking intensity on each lipoprotein was small. Relationships between the Fagerström Test of Nicotine Dependence score and lipoproteins were weak and inconsistent. Participants in the lowest quintiles of current smoking, pack-years, and CO had more favorable lipoproteins (all P < .04).ConclusionsAmong current smokers, increased smoking burden is associated with small increases in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Increased recent smoke exposure is associated with small decreases in HDL-C and HDL particles.