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Influence of cigarette smoking on coronary artery and aortic calcium among random samples from populations of middle-aged Japanese and Korean men
  1. Nobutaka Hirooka1,2,
  2. Takashi Kadowaki3,
  3. Akira Sekikawa3,4,
  4. Hirotsugu Ueshima3,
  5. Jina Choo5,
  6. Katsuyuki Miura3,
  7. Tomonori Okamura6,
  8. Akira Fujiyoshi3,
  9. Sayaka Kadowaki3,
  10. Aya Kadota3,
  11. Yasuyuki Nakamura7,
  12. Hiroshi Maegawa8,
  13. Atsunori Kashiwagi9,
  14. Kamal Masaki10,
  15. Kim Sutton-Tyrrell4,
  16. Lewis H Kuller4,
  17. J David Curb10,
  18. Chol Shin11
  1. 1Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
  2. 2Family Medicine Faculty Development Fellowship, UPMC Shadyside, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Department of Health Science, Shiga University of Medical Science, Otsu, Japan
  4. 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5College of Nursing, Korea University, Seoul, South Korea
  6. 6Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
  7. 7Cardiovascular Epidemiology, Kyoto Women's University, Kyoto, Japan
  8. 8Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
  9. 9Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
  10. 10Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
  11. 11Division of Pulmonary Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
  1. Correspondence to Dr Akira Sekikawa, 130 North Bellefield Avenue, Suite 546, Pittsburgh, PA 15213, USA; akira{at}


Background Cigarette smoking is a risk factor of coronary heart disease. Vascular calcification such as coronary artery calcium (CAC) and aortic calcium (AC) is associated with coronary heart disease. The authors hypothesised that cigarette smoking is associated with coronary artery and aortic calcifications in Japanese and Koreans with high smoking prevalence.

Methods Random samples from populations of 313 Japanese and 302 Korean men aged 40–49 years were examined for calcification of the coronary artery and aorta using electron beam CT. CAC and AC were quantified using the Agatston score. The authors examined the associations of cigarette smoking with CAC and AC after adjusting for conventional risk factors and alcohol consumption. Current and past smokers were combined and categorised into two groups using median pack-years as a cut-off point in each of Japanese and Koreans. The never-smoker group was used as a reference for the multiple logistic regression analyses.

Results The ORs of CAC (score ≥10) for smokers with higher pack-years were 2.9 in Japanese (p<0.05) and 1.3 in Koreans (non-significant) compared with never-smokers. The ORs of AC (score ≥100) for smokers with higher pack-years were 10.4 in Japanese (p<0.05) and 3.6 in Koreans (p<0.05).

Conclusion Cigarette smoking with higher pack-years is significantly associated with CAC and AC in Japanese men, while cigarette smoking with higher pack-years is significantly associated with AC but not significantly with CAC in Korean men.

  • Atherosclerosis
  • cigarette smoking
  • coronary calcium
  • aortic calcium
  • Japanese
  • Koreans
  • coronary heart disease
  • epidemiology
  • smoking
  • vascular disease

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  • Funding This work was supported by grants R01 HL68200 and HL071561 from the National Institute of Health, Korea Center for Disease Control and Prevention (Government budget code: 2004-E71001-00, 205-E71001-00)and grants B16790335, A13307016, A17209023 and A21249043 by the Japanese Ministry of Education, Culture, Sports, Science and Technology.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Institutional Review Boards of Shiga University of Medical Science, Shiga, Japan; the Korean University, Seoul, South Korea; and the University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data under ERA-JUMP study would be shared based on the request.