ArticleAmerican journal of preventive cardiology2027
Absence of significant coronary artery disease does not eliminate smoking-related cardiovascular risk: insights from the PROMISE trial.
Article in American journal of preventive cardiology, 2027. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Background: Although the relationship between smoking and cardiovascular events is well established, it remains uncertain whether the outcomes of noninvasive testing (NIT) influence this relationship and how systemic biomarkers may aid risk stratification in patients presenting with chest pain. Methods: This study included PROMISE participants with stable chest pain and available smoking status (current, ever, or never) and NIT results (Positive NIT: ≥70% coronary stenosis on CT angiography or inducible ischemia on stress testing). Smoking was associated with systemic biomarkers (e.g., hsCRP, IL-6, MMP-9), NIT results, and major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, unstable angina), using regression and mediation models adjusted for traditional cardiovascular risk factors (median follow-up 24.4 months). Results: Among 9100 individuals (mean age 61±8 years; 53% female), 51% were ever-smokers, including 18% current smokers. Smoking was independently associated with MACE, with positive NIT mediating this relationship (current: 16%; ever: 12%, Conclusions: Negative NIT does not reduce smoking-associated MACE risk in patients with stable chest pain. Particularly, current smoking confers substantial residual cardiovascular risk, potentially mediated by MMP-9-related matrix remodeling not captured by standard testing, supporting aggressive smoking cessation irrespective of NIT results.
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