CAD AND SMOKING
Both cigarette smoking and high blood pressure (BP) are important modifiable risk factors that play significant roles in the development of coronary heart disease (CHD), which accounts for a striking global burden of premature death in both developing and industrialized regions.

Reference:
Peinemann, F., Moebus, S., Dragano, N., Mohlenkamp, S., Lehmann, N., Zeeb, H., & … Hoffmann, B. (2011). Secondhand Smoke Exposure and Coronary Artery Calcification among Nonsmoking Participants of a Population-Based Cohort. Environmental Health Perspectives, 119(11), 1556-1561.
Abstract: Background: Secondhand smoke (SHS) consists of fine particulate matter, carcinogens, and various toxins that affect large parts of the population. SHS increases the risk for acute cardiovascular events and may contribute to the development of atherosclerosis. Objectives: We investigated the association of SHS with coronary artery calcification (CAC). Methods: In this cross-sectional analysis, we used baseline data (2000-2003) from 1,766 never-smokers without clinically manifested coronary heart disease, 45-75 years of age, from the Heinz Nixdorf Recall Study, an ongoing, prospective, population-based cohort study in Germany. Self-reported frequent SHS at home, at work, and in other places was assessed by questionnaire. CAC scores were derived based on electron-beam computed tomography. We conducted multiple linear regression analysis using exposure to SHS as the explanatory variable and In (CAC+1) as the response variable. We conducted logistic regression to estimate the odds ratio (OR) for presence of any CAC. Results: Frequent exposure to SHS was reported by 21.5% of participants. After adjustment forage, sex, and socioeconomic status, CAC + 1 was 21.1% [95% confidence interval (CI): -5.5%, 55.2%] higher in exposed than in unexposed participants. After adjusting for other cardiovascular risk factors, the association was attenuated (15.4%; 95% CI: -9.6%, 47.2%). SHS exposure was also associated with a CAC score > 0 (fully adjusted OR = 1.38; 95% CI: 1.03, 1.84). Conclusions: Self-reported frequent exposure to SHS was associated with sub clinical coronary atherosclerosis in our cross-sectional study population. Considering the widespread exposure and the clinical relevance of coronary atherosclerosis, this result, if confirmed, is of public health importance.

Wang, H., Harrell, J., & Funk, S. (2008). Factors associated with smoking cessation among male adults with coronary heart disease in Taiwan. Journal of Nursing Research (Taiwan Nurses Association), 16(1), 55-64.
Abstract: The purpose of this study was to examine factors associated with smoking cessation behavior among male adult smokers hospitalized for a cardiac event in Taiwan during the three-month period following their discharge from hospital. A longitudinal co relational design using two structured questionnaires and two phone interviews was employed to collect data. A convenient sampling was adopted. Among the 250 potential participants recruited, 148 provided completed data and were included as study subjects. Three months after hospital discharge, 43.9% of subjects were defined as “continuous abstainers” (i.e., not a single cigarette puff taken during this period), 33.8% were “non-continuous abstainers” (i.e., abstained for at least 1 day, but had smoked at some point during this period), and 22.3% were “continuous smokers” (i.e., had not abstained from smoking for any period equal to or exceeding 24 hours during this period). Multivariate analysis (hierarchical logistic regression) revealed that subjects with higher self-efficacy in not smoking and greater perceived positive family support were more likely to quit smoking for at least 24 hours (i.e., “attempters”). Attempters who stayed in hospital for longer periods of time, had higher self-efficacy in not smoking or perceived more positive and fewer negative family support behaviors were more likely to become continuous abstainers. These results suggest that self-efficacy and family support should be addressed in any intervention program targeting smoking cessation in male patients with coronary heart disease.

Sun, D., Cao, J., Liu, X., Yu, L., Yao, C., Li, J., & … Gu, D. (2010). Combined effects of smoking and systolic blood pressure on risk of coronary heart disease: a cohort study in Chinese women. Journal Of Womens Health (15409996), 19(4), 713-718. doi:10.1089/jwh.2009.1486.
Abstract: OBJECTIVES: To quantify the combined effects of systolic blood pressure (SBP) and cigarette smoking on incident coronary heart disease (CHD) in women. METHODS: Overall, 86,338 women aged >or=40 years were enrolled in 1991. The follow-up evaluation was conducted in 1999-2000, with a response rate of 92.9%. RESULTS: A total of 829 CHD events (fatal and nonfatal) were observed among the participants who were free of cardiovascular diseases (CVD) at baseline. Higher SBP was significantly associated with more risk of CHD in both nonsmokers and current smokers (all p < 0.0001 for linear trends). Comparing with never smoking, both low and high levels of cigarettes smoked per day (1-7, and >or=8 cigarettes per day) and pack-years (or=10 pack-years) were associated with increased risk of CHD in those with normal and high SBP. The multivariate adjusted relative risks (RRs) of CHD were 2.54 (95% confidence interval [CI] 2.00-3.23), 1.28 (1.01-1.63), and 1.57 (1.33-1.86) for current smokers with high SBP, current smokers with normal SBP, and nonsmokers with high SBP, respectively, compared with nonsmokers with normal SBP. The present study identified a statistically significant additive interaction between these two factors on CHD. CONCLUSIONS: Our study indicated that the combined effects of cigarette smoking and high SBP could be expected to have extra adverse effects on CHD in women, which highlights the importance of multifactor interventions to decrease the risk of CHD, for example, quitting smoking and treatment of high blood pressure in Chinese women.