Participants from the Framingham Heart Study who were exposed to tobacco had higher absolute pulmonary blood vessel volume, higher small vessel volume, and/or higher small vessel fraction than those with less exposure, according to the results of a recent study published in the Annals of the American Thoracic Society.

Inspiratory, noncontrast, whole-lung computed tomography scans were used to generate 3-dimensional reconstructions of the pulmonary vasculature from participants from the Framingham Heart Study. The volume of vessels of varying cross-sectional areas were calculated and compared between groups based on relative tobacco exposure.

Of the 2410 study participants, 1168 were never smokers, 1064 were former smokers, and 178 were current smokers (mean age, 59.1 years; 51.1% women). Former and current smokers reported an average of 16.9 and 32.7 pack-years, respectively, whereas 25.7% of study participants reported secondhand smoke exposure during adulthood.

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Cigarette smoke was consistently associated with higher absolute pulmonary blood vessel volumes and/or higher small vessel fraction. Ever-smoking status was associated with higher total volume of all intrapulmonary vessels, of smaller peripheral vessels, and of the relative fraction of small vessels compared with never-smokers. Furthermore, the magnitude of effect of tobacco exposure on blood vessel volumes increased linearly when comparing never, former, and current smokers.

“Using [computed tomography] imaging, we found that cigarette exposure was associated with higher pulmonary blood vessel volumes, especially in the smaller peripheral vessels,” the researchers wrote. “While histologically, tobacco-related vasculopathy is characterized by vessel narrowing and loss, our results suggest that radiographic vascular pruning may not be a surrogate of these pathologic changes.”

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Disclosures: Several authors report financial relationships with Boehringer Ingelheim, Biogen, Genentech, Quantitative Imaging Solutions, PulmonX, Regeneron, ModoSpira, BTG Interventional Medicine, Janssen Pharmaceuticals, Toshiba, GlaxoSmithKline, and AstraZeneca.


Synn A, Zhang C, Washko G, et al. Cigarette smoke exposure and radiographic pulmonary vascular morphology in the Framingham Heart Study [published February 4, 2019]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201811-795OC