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European Journal of Epidemiology

, Volume 22, Issue 5, pp 311–317 | Cite as

Association between tobacco smoke exposure and levels of C-reactive protein in the Oslo II Study

  • Christian MadsenEmail author
  • Per Nafstad
  • Lars Eikvar
  • Per E. Schwarze
  • Kjersti S. Rønningen
  • Lise Lund Haaheim
Cardiovascular disease

Abstract

It is well known that tobacco smoke exposure is related to the risk of developing cardiovascular diseases and events. One mechanism could be that tobacco smoke acts on the cardiovascular system by altering the autonomic function and/or inducing inflammatory responses. We used data from 3 744 men aged 67–77 years from the city of Oslo that participated in the health screening for the Oslo II Health Study in 2000, to explore associations between C-reactive protein and environmental exposures including exposure to tobacco smoke products. Levels of C-reactive protein were higher in current smokers (2.05 mg/l, IQR, 1.11–4.17 mg/l), compared to former-smokers (1.58 mg/l, IQR, 0.83–3.03 mg/l) and non-smokers (1.26 mg/l, IQR, 0.65–2.40 mg/l). The risk of elevated C-reactive protein increased with both numbers of current cigarettes smoked per day and numbers of pack-years of smoking, when other factors were adjusted for (P < 0.001). We found a positive dose–response relationship between amount of current cigarette smoking and elevated C-reactive protein levels. These findings support the idea that the induction or exacerbation of inflammation could be a mechanism by which smoking promotes atherosclerotic cardiovascular diseases.

Keywords

C-reactive protein Tobacco smoke exposure Pack-years of smoking Environmental exposure Cardiovascular disease Cross-sectional study 

Abbreviations

CRP

C-reactive protein

TSE

tobacco smoke exposure

PYS

pack-years of smoking

EE

environmental exposure.

Notes

Acknowledgements

The data collection was conducted in coordination with and prior to the Oslo Health Study 2000–2001 in collaboration with the Norwegian Institute of Public Health, the City of Oslo and Ullevål University Hospital in Oslo. This research was supported by grants from the University of Oslo and the Norwegian Public Roads Administration. We also wish to thank Lars Lundby for valuable help with the data collection, and Anne Johanne Søgaard for valuable help.

References

  1. 1.
    Chen Z, Boreham J. Smoking and cardiovascular disease. Semin Vasc Med 2002;2:243–52PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel WB, D’Agostino RB, Belanger AJ. Fibrinogen, cigarette smoking, and risk of cardiovascular disease: insights from the Framingham Study. Am Heart J 1987;113:1006–10PubMedCrossRefGoogle Scholar
  3. 3.
    Ludvig J, Miner B, Eisenberg MJ. Smoking cessation in patients with coronary artery disease. Am Heart J 2005;149:565–72PubMedCrossRefGoogle Scholar
  4. 4.
    Miettinen OS, Neff RK, Jick H. Cigarette-smoking and nonfatal myocardial infarction: rate ratio in relation to age, sex and predisposing conditions. Am J Epidemiol 1976;103:30–6PubMedGoogle Scholar
  5. 5.
    Neaton JD,.Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992;152:56–64PubMedCrossRefGoogle Scholar
  6. 6.
    Rosengren A, Wilhelmsen L, Wedel H. Coronary heart disease, cancer and mortality in male middle-aged light smokers. J Intern Med 1992;231:357–62PubMedCrossRefGoogle Scholar
  7. 7.
    Steenland K, Thun M, Lally C, Heath C Jr. Environmental tobacco smoke and coronary heart disease in the American Cancer Society CPS-II cohort. Circulation 1996;94:622–8PubMedGoogle Scholar
  8. 8.
    Hermanson B, Omenn GS, Kronmal RA, Gersh BJ. Beneficial 6-year outcome of smoking cessation in older men and women with coronary artery disease. Results from the CASS registry. N Engl J Med 1988;319:1365–9PubMedCrossRefGoogle Scholar
  9. 9.
    Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004;43:1731–7PubMedCrossRefGoogle Scholar
  10. 10.
    Tracy RP, Lemaitre RN, Psaty BM, Ives DG, Evans RW, Cushman M et al. Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arterioscler Thromb Vasc Biol 1997;17:1121–7PubMedGoogle Scholar
  11. 11.
    Rifai N,.Ridker PM. Inflammatory markers and coronary heart disease. Curr Opin Lipidol 2002;13:383–9PubMedCrossRefGoogle Scholar
  12. 12.
    Ferreiros ER, Boissonnet CP, Pizarro R, Merletti PF, Corrado G, Cagide A et al. Independent prognostic value of elevated C-reactive protein in unstable angina. Circulation 1999;100:1958–63PubMedGoogle Scholar
  13. 13.
    Papanicolaou DA, Wilder RL, Manolagas SC, Chrousos GP. The pathophysiologic roles of interleukin-6 in human disease. Ann Intern Med 1998;128:127–37PubMedGoogle Scholar
  14. 14.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997;336:973–9PubMedCrossRefGoogle Scholar
  15. 15.
    Ridker PM, Rifai N, Pfeffer MA, Sacks F, Braunwald E. Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1999;100:230–5PubMedGoogle Scholar
  16. 16.
    van Exel E, Gussekloo J, de Craen AJ. Bootsma-van der Wiel A, Frolich M, Westendorp RG. Inflammation and stroke: the Leiden 85-Plus Study. Stroke 2002;33:1135–8PubMedCrossRefGoogle Scholar
  17. 17.
    Cushman M, Arnold AM, Psaty BM, Manolio TA, Kuller LH, Burke GL et al. C-reactive protein and the 10-year incidence of coronary heart disease in older men and women: the cardiovascular health study. Circulation 2005;112:25–31PubMedCrossRefGoogle Scholar
  18. 18.
    Haheim LL, Lund Larsen PG, Sogaard AJ, Holme I. Risk factors associated with body mass index increase in men at 28 years follow-up. QJM 2006;99:665–71CrossRefGoogle Scholar
  19. 19.
    Haheim LL, Holme I, Hjermann I, Leren P. Smoking habits and risk of fatal stroke: 18 years follow up of the Oslo Study. J Epidemiol Commu Health 1996;50:621–4CrossRefGoogle Scholar
  20. 20.
    Torres JL, Ridker PM. High sensitivity C-reactive protein in clinical practice. Am Heart Hosp J 2003;1:207–11PubMedCrossRefGoogle Scholar
  21. 21.
    Ridker PM. Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke. Circulation 2003;108:e81–5PubMedCrossRefGoogle Scholar
  22. 22.
    Walker SE, Slordal LH, Guerreiro C, Gram F, Gronskei KE. Air pollution exposure monitoring and estimation. Part II. Model evaluation and population exposure. J Environ Monit 1999;1:321–6PubMedCrossRefGoogle Scholar
  23. 23.
    Oftedal B, Walker SE, Gram F, McInnes H, Nafstad P. Modelling long-term averages of local ambient air pollution in Oslo, Norway: evaluation of nitrogen dioxide, PM10 and PM2.5. Int J Environ Pollut 2006. Google Scholar
  24. 24.
    Bermudez EA, Rifai N, Buring JE, Manson JE, Ridker PM. Relation between markers of systemic vascular inflammation and smoking in women. Am J Cardiol 2002;89:1117–9PubMedCrossRefGoogle Scholar
  25. 25.
    Rohde LE, Hennekens CH, Ridker PM. Survey of C-reactive protein and cardiovascular risk factors in apparently healthy men. Am J Cardiol 1999;84:1018–22PubMedCrossRefGoogle Scholar
  26. 26.
    Donaldson K, Stone V, Seaton A, MacNee W. Ambient particle inhalation and the cardiovascular system: potential mechanisms. Environ Health Perspect 2001;109(Suppl 4):523–7PubMedCrossRefGoogle Scholar
  27. 27.
    Seaton A, Soutar A, Crawford V, Elton R, McNerlan S, Cherrie J et al. Particulate air pollution and the blood. Thorax 1999;54:1027–32PubMedCrossRefGoogle Scholar
  28. 28.
    Maraldi C, Volpato S, Kritchevsky SB, Cesari M, Andresen E, Leeuwenburgh C et al. Impact of inflammation on the relationship among alcohol consumption, mortality, and cardiac events: the health, aging, and body composition study. Arch Intern Med 2006;166:1490–7PubMedCrossRefGoogle Scholar
  29. 29.
    Prasad K. C-reactive protein and cardiovascular diseases. IntI J Angiol 2003;1–12Google Scholar
  30. 30.
    Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clin Invest 1993;91:1351–7PubMedCrossRefGoogle Scholar
  31. 31.
    U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke. 2006Google Scholar
  32. 32.
    Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Masoura C, Toutouzas P et al. Effect of exposure to secondhand smoke on markers of inflammation: the ATTICA study. Am J Med 2004;116:145–50PubMedCrossRefGoogle Scholar
  33. 33.
    Moschos N, Christoforaki M, Antonatos P. Seasonal distribution of acute myocardial infarction and its relation to acute infections in a mild climate. Int J Cardiol 2004;93:39–44PubMedCrossRefGoogle Scholar
  34. 34.
    Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol 1998;31:1226–33PubMedCrossRefGoogle Scholar
  35. 35.
    Sung KC. Seasonal variation of C-reactive protein in apparently healthy Koreans. Int J Cardiol 2006;107:338–42PubMedCrossRefGoogle Scholar
  36. 36.
    Frohlich M, Sund M, Thorand B, Hutchinson WL, Pepys MB, Koenig W. Lack of seasonal variation in C-reactive protein. Clin Chem 2002;48:575–7PubMedGoogle Scholar
  37. 37.
    Wang AY, Woo J, Lam CW, Wang M, Sea MM, Lui SF et al. Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? J Am Soc Nephrol 2003;14:1871–9PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Christian Madsen
    • 1
    Email author
  • Per Nafstad
    • 1
    • 2
  • Lars Eikvar
    • 3
  • Per E. Schwarze
    • 4
  • Kjersti S. Rønningen
    • 1
  • Lise Lund Haaheim
    • 5
  1. 1.Division of EpidemiologyNorwegian Institute of Public HealthOsloNorway
  2. 2.Institute of General Practice and Community MedicineUniversity of OsloOsloNorway
  3. 3.Department of Clinical ChemistryUllevaal University HospitalOsloNorway
  4. 4.Division of Environmental MedicineNorwegian Institute of Public HealthOsloNorway
  5. 5.Norwegian Knowledge Centre for the Health ServicesOsloNorway

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