Abstract 2871: Positive Interaction between Smoking and High-sensitivity C-reactive Protein in the Development of Coronary Vasospasm in Patients without Hemodynamically Significant Coronary Artery Disease
Background: Interactions between 2 major risk factors, smoking and high-sensitivity C-reactive protein (hs-CRP), in patients with coronary vasospasm without hemodynamically significant coronary artery disease (CAD) have not been evaluated.
Method and Results: Patients undergoing diagnostic coronary angiography with proven coronary vasospasm (> 70% vessel diameter reduction during intracoronary methylergonovine infusion as compared with the diameter following intracoronary nitroglycerin) but without coronary stenosis > 50% were evaluated. A total of 646 patients including 289 patients without coronary vasospasm and 357 with coronary vasospasm were analyzed. The levels of hs-CRP measured immediately before coronary angiography were examined in a subset of 339 patients. Patients with coronary vasospasm were likely to be older, men, current smokers, and to have high levels of hs-CRP. Hs-CRP level appeared to be the most significant factor of coronary vasospasm (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.00 –1.08, p = 0.033). The likelihood of male smokers developing coronary vasospasm was higher than that of female nonsmokers (OR = 4.00, 95% CI = 2.65– 6.05, p < 0.001). Among smokers, an elevated risk was found from the lowest to the middle tertiles of hs-CRP; OR from 0.88 to 2.73 (CI = 1.11– 6.70, p = 0.029). In the analysis of nonsmokers, the ORs for 3 tertiles of hs-CRP were 1.00, 0.84, and 2.41 (CI = 1.14 –5.06, p = 0.021) from the lowest to the highest tertiles (figure⇓).
Conclusion: Smokers developed coronary vasospasm at a lower hs-CRP level than nonsmokers. There is a positive interaction between smoking and hs-CRP in this disease.