{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:44:03Z","timestamp":1791582243905,"version":"4.3.4"},"reference-count":37,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cigarette smoking is a major modifiable risk factor for cardiovascular disease. Despite the widespread use of coronary artery calcium (CAC) scoring as a risk stratifier for preventive therapy, smokers frequently present with acute coronary syndromes despite minimal coronary calcification. We performed a multimodality meta-analysis to quantify the association between smoking and coronary plaque burden and phenotype using CCTA, IVUS, and OCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We systematically searched multiple databases through June 2026 for imaging studies comparing smokers with never-smokers. Random-effects meta-analyses using inverse-variance weighting were performed to pool odds ratios (ORs) for plaque presence and specific phenotypes; heterogeneity was assessed using the I2 statistic. Sixteen studies (n = 251 839; mean age 58 years; 65% male) met the inclusion criteria. In pooled analyses, smokers had higher odds of any detectable coronary plaque (OR 1.42; 95% CI 1.32\u20131.53). Smoking was associated with increased odds of both calcified plaque (OR 1.33; 95% CI 1.11\u20131.58) and non-calcified plaque (OR 1.59; 95% CI 1.47\u20131.73), with a more consistent and homogeneous association observed for non-calcified plaque. Mixed plaque was also more frequent in smokers (OR 1.52; 95% CI 1.31\u20131.78).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cigarette smoking is associated with greater coronary plaque burden and a relative excess of non-calcified plaque compared with never-smoking. These findings suggest that plaque phenotypes in smokers may not be fully reflected by CAC scoring alone. Prospective multimodality cohorts with individual-level CAC and plaque characterization are needed to further refine risk stratification in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag453","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T21:01:26Z","timestamp":1788296486000},"source":"Crossref","is-referenced-by-count":1,"title":["Cigarette smoking, coronary plaque burden and phenotype: a multimodality meta-analysis and implications for coronary artery calcium scoring in prevention"],"prefix":"10.1093","author":[{"given":"Sneha Annie","family":"Sebastian","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Augusta Health , Fishersville, VA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia","family":"Bimal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , 440 W 114th St 2nd Fl, Ste 220, New York, NY 10025 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , 440 W 114th St 2nd Fl, Ste 220, New York, NY 10025 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , 440 W 114th St 2nd Fl, Ste 220, New York, NY 10025 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekhar","family":"Vohra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , 440 W 114th St 2nd Fl, Ste 220, New York, NY 10025 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2256-0888","authenticated-orcid":false,"given":"Vikram","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai , 440 W 114th St 2nd Fl, Ste 220, New York, NY 10025 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"2026091001512369900_zwag453-B1","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.acra.2019.08.017","article-title":"Coronary artery plaque burden in smokers and never-smokers: quantification with cardiac CT","volume":"26","author":"Meinel","year":"2019","journal-title":"Acad Radiol"},{"key":"2026091001512369900_zwag453-B2","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.acra.2019.03.017","article-title":"Coronary atherosclerotic plaque volume quantified by computed tomographic angiography in smokers compared to nonsmokers","volume":"26","author":"Hou","year":"2019","journal-title":"Acad Radiol"},{"key":"2026091001512369900_zwag453-B3","doi-asserted-by":"crossref","first-page":"572","DOI":"10.5144\/0256-4947.2013.572","article-title":"Young coronary artery disease in patients undergoing percutaneous coronary intervention","volume":"33","author":"Zuhdi","year":"2013","journal-title":"Ann Saudi Med"},{"key":"2026091001512369900_zwag453-B4","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1016\/j.jacc.2018.02.079","article-title":"Coronary atherosclerotic precursors of acute coronary syndromes","volume":"71","author":"Chang","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026091001512369900_zwag453-B5","doi-asserted-by":"crossref","first-page":"C13","DOI":"10.1016\/j.jacc.2005.10.065","article-title":"Pathology of the vulnerable plaque","volume":"47","author":"Virmani","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"2026091001512369900_zwag453-B6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0141093","article-title":"Smoking in relation to coronary atherosclerotic plaque burden, volume and composition on intravascular ultrasound","volume":"10","author":"Buljubasic","year":"2015","journal-title":"PLoS One"},{"key":"2026091001512369900_zwag453-B7","first-page":"398","article-title":"Influence of cigarette smoking on burden and characteristics of coronary artery plaques in Chinese men","volume":"31","author":"Sun","year":"2015","journal-title":"Acta Cardiol Sin"},{"key":"2026091001512369900_zwag453-B8","doi-asserted-by":"crossref","first-page":"482","DOI":"10.7150\/ijms.79889","article-title":"Smoking and unstable plaque in acute coronary syndrome: a systematic review of the role of matrix metalloproteinases","volume":"20","author":"Aminuddin","year":"2023","journal-title":"Int J Med Sci"},{"key":"2026091001512369900_zwag453-B9","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Higgins","year":"2024"},{"key":"2026091001512369900_zwag453-B10","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2026091001512369900_zwag453-B11","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1037\/h0026256","article-title":"Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit","volume":"70","author":"Cohen","year":"1968","journal-title":"Psychol Bull"},{"key":"2026091001512369900_zwag453-B12","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2024.108602","article-title":"A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E)","volume":"186","author":"Higgins","year":"2024","journal-title":"Environ Int"},{"key":"2026091001512369900_zwag453-B13","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5.1","author":"Sch\u00fcnemann","year":"2024"},{"key":"2026091001512369900_zwag453-B14","author":". Review Manager Web (RevMan Web)"},{"key":"2026091001512369900_zwag453-B15","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2026091001512369900_zwag453-B16","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"2026091001512369900_zwag453-B17","article-title":"Smoking and coronary atherosclerosis: disproportionate impact on the right coronary artery","volume":"4","author":"Dahlgren","year":"2025","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"2026091001512369900_zwag453-B18","doi-asserted-by":"crossref","first-page":"A1631","DOI":"10.1016\/S0735-1097(18)32172-7","article-title":"The impact of cigarette smoking for high-risk coronary plaque development and plaque progression by serial coronary computed tomography angiography.","volume":"71","author":"Park","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026091001512369900_zwag453-B19","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/MCA.0000000000000168","article-title":"Impact of cigarette smoking on coronary plaque composition","volume":"26","author":"Kumagai","year":"2015","journal-title":"Coron Artery Dis"},{"key":"2026091001512369900_zwag453-B20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0147822","article-title":"Associations between tobacco, alcohol, and drug use with coronary artery plaque among HIV-infected and uninfected men in the multicenter AIDS cohort study","volume":"11","author":"Kelly","year":"2016","journal-title":"PLoS One"},{"key":"2026091001512369900_zwag453-B21","article-title":"Persistent cigarette smoking attenuates plaque stabilization in response to lipid-lowering therapy: a serial optical coherence tomography study","volume":"8","author":"Zhang","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2026091001512369900_zwag453-B22","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/MCA.0000000000000268","article-title":"Age-related effects of smoking on culprit lesion plaque vulnerability as assessed by grayscale and virtual histology-intravascular ultrasound","volume":"26","author":"Kang","year":"2015","journal-title":"Coron Artery Dis"},{"key":"2026091001512369900_zwag453-B23","first-page":"354","article-title":"Comparison of coronary atherosclerotic plaque burden and composition of culprit lesions between cigarette smokers and non-smokers by in vivo virtual histology intravascular ultrasound","volume":"27","author":"Bolorunduro","year":"2015","journal-title":"J Invasive Cardiol"},{"key":"2026091001512369900_zwag453-B24","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2024064","article-title":"Association between smoking status and subclinical coronary atherosclerosis in asymptomatic Korean individuals","volume":"46","author":"Lee","year":"2024","journal-title":"Epidemiol Health"},{"key":"2026091001512369900_zwag453-B25","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.atherosclerosis.2016.11.016","article-title":"Association of tobacco use and cessation with coronary atherosclerosis","volume":"257","author":"Cheezum","year":"2017","journal-title":"Atherosclerosis"},{"key":"2026091001512369900_zwag453-B26","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.ihj.2021.09.005","article-title":"Effect of smoking on culprit lesion plaque burden and composition in acute coronary syndrome: an intravascular ultrasound-virtual histology study","volume":"73","author":"Kadiyala","year":"2021","journal-title":"Indian Heart J"},{"key":"2026091001512369900_zwag453-B27","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2021.750773","article-title":"Effect of smoking on coronary artery plaques in type 2 diabetes Mellitus: evaluation with coronary computed tomography angiography","volume":"12","author":"Jiang","year":"2021","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026091001512369900_zwag453-B28","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s10554-013-0224-8","article-title":"Relationship between amount of cigarette smoking and coronary atherosclerosis on coronary CTA in asymptomatic individuals","volume":"29","author":"Kim","year":"2013","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026091001512369900_zwag453-B29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s10554-015-0738-3","article-title":"Coronary CT angiography findings based on smoking status: do ex-smokers and never-smokers share a low probability of developing coronary atherosclerosis?","volume":"31","author":"Yi","year":"2015","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026091001512369900_zwag453-B30","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.1016\/j.jcct.2025.05.080","article-title":"Association between smoking and coronary artery diseases verified by Ct angiography findings: a systematic review and meta-analysis","volume":"19","author":"Irannejad","year":"2025","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026091001512369900_zwag453-B31","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1161\/CIRCULATIONAHA.123.067626","article-title":"Development and validation of the American Heart Association\u2019s PREVENT equations","volume":"149","author":"Khan","year":"2024","journal-title":"Circulation"},{"key":"2026091001512369900_zwag453-B32","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajpc.2025.101288","article-title":"Cardiovascular disease risk estimates using the new PREVENT equation: the good, bad, and the ugly","volume":"24","author":"Selvam","year":"2025","journal-title":"Am J Prev Cardiol"},{"key":"2026091001512369900_zwag453-B33","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.jcin.2019.07.028","article-title":"The \u201csmoker's paradox\u201d: the closer you Look, the less you see","volume":"12","author":"Joner","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2026091001512369900_zwag453-B34","article-title":"Correlation and agreement between the SCORE2 and PREVENT 10-year atherosclerotic cardiovascular disease risk scores: insights from coronary computed tomography angiography","volume":"14","author":"Ozpelit","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"2026091001512369900_zwag453-B35","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1093\/eurheartj\/ehab309","article-title":"SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe","volume":"42","author":"SCORE2 working group and ESC Cardiovascular risk collaboration","year":"2021","journal-title":"Eur Heart J"},{"key":"2026091001512369900_zwag453-B36","doi-asserted-by":"crossref","first-page":"903","DOI":"10.3390\/jcm15020903","article-title":"Artificial intelligence in coronary plaque characterization: clinical implications, evidence gaps, and future directions","volume":"15","author":"Benjanuwattra","year":"2026","journal-title":"J Clin Med"},{"key":"2026091001512369900_zwag453-B37","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2025.133140","article-title":"Artificial intelligence driven plaque characterization and functional assessment from CCTA using OCT-based automation: a prospective study","volume":"428","author":"Han","year":"2025","journal-title":"Int J Cardiol"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwag453\/70896093\/zwag453.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwag453\/70896093\/zwag453.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:51:32Z","timestamp":1789019492000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article\/doi\/10.1093\/eurjpc\/zwag453\/8778768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":37,"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwag453","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"article-number":"zwag453"}}