Smoking and the Pathogenesis of Atherosclerosis
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This symposium occurs just a little over 30 years after the landmark study of Hammond and Horn (1958) that, for the first time, conclusively linked smoking with coronary heart disease and other sequelae of atherosclerosis. The effect of that report is difficult to appreciate with our present knowledge, but one measure of its significance is that as late as 1948, coronary heart disease patients were included as controls for studies of smoking and lung cancer (Doll, 1984). Many changes have occurred since 1958: the prevalence of smoking among U.S. adults has declined by more than a half , and the coronary heart disease death rate has declined by one third. The association of smoking with atherosclerotic cardiovascular disease has been strengthened by hundreds of observational studies which have been so unanimous in their results that the question about smoking and atherosclerotic disease is no longer whether, but how. The observation that cessation of smoking reduced risk of coronary heart disease further strengthened the idea of a causal relationship. On the question of mechanisms, we are much less informed. As the presentations in this symposium will probably show, there are many possibilities, but few certainties.
KeywordsCoronary Heart Disease Atherosclerotic Disease Cholesteryl Ester Transfer Protein Coronary Heart Disease Patient High Density Lipoprotein Cholesterol Level
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