The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a meta-analysis

doi:10.1016/S0091-7435(03)00110-5

Preventive Medicine

Volume 37, Issue 4, October 2003, Pages 283-290

https://doi.org/10.1016/S0091-7435(03)00110-5 Get rights and content

Abstract

Background

Cross-sectional studies revealed that cigarette smokers have lower high-density lipoprotein cholesterol (HDL-C) levels and higher levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) than nonsmokers. But prospective studies on the effects of cigarette smoking cessation on lipid profile have yielded inconclusive results.

Methods

Relevant English articles were retrieved by keyword searches of MEDLINE (1966–October 2000), Cochrane Library (2000, Issue 2), and cited references. Twenty-seven studies met the following inclusion criteria: (1) prospective cohort study including clinical trials, (2) measuring smoking status and lipid profile of HDL-C, TC, LDL-C, and TG, (3) reporting the changes of lipid concentrations in abstinent smokers, and (4) not using adjuvant antihyperlipidemic drugs.

Results

Overall Q statistics for net change of HDL-C, TC, LDL-C, and TG showed heterogeneity. Using a random-effects model, HDL-C level increased significantly {0.100 (CI 0.074 to 0.127) mmol/L} after smoking cessation. However, levels of TC {+0.003 (CI −0.042 to 0.048)}, LDL-C {−0.064 (CI −0.149 to 0.021), and TG {+0.028 (CI −0.014 to 0.071)} did not change significantly after smoking cessation.

Conclusions

Cigarette smoking cessation increases serum levels of HDL-C but not of TC, LDL-C, and TG.

Introduction

Cigarette smoking is widely accepted as a major risk factor for the development of cardiovascular disease [1]. Several possible explanations have been proposed for this association, including altered blood coagulation, impaired integrity of the arterial wall, and changes in blood lipid concentrations [2].

A meta-analysis of cross-sectional studies on the association of lipid profiles and cigarette smoking status revealed that smokers had higher serum concentrations of total cholesterol (3.0%), triglycerides (9.1%), very-low-density lipoprotein cholesterol (10.4%), and low-density lipoprotein cholesterol (1.7%) and lower serum concentrations of high-density lipoprotein cholesterol (−5.7%) and apolipoprotein A1 (−4.2%) than nonsmokers [3].

However, prospective cohort studies and experimental studies [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30] examining the effects of cigarette smoking cessation on lipid profile have so far provided only inconclusive results. We therefore performed a meta-analysis to estimate of the effects of cigarette smoking cessation on lipid profile.

Section snippets

Methods

The databases of MEDLINE (January 1966–August 2000) and Cochrane Library/CCTR (2000, Issue 2) were searched for all prospective studies measuring smoking status and lipid profile simultaneously. Our aim was to summarize the degree of the effect of smoking cessation itself, not of smoking cessation intervention, on lipid profile. Database search strategies used the Medical Subject Heading (MeSH) terms “tobacco use cessation,” “cholesterol,” “triglycerides,” and “smoking,” “tobacco,” “cigar,”

Initial search and preliminary selection (Fig. 1; Table 1)

After the initial screening, 91 of 375 original citations were accepted for further assessment. Of these, 61 did not meet the inclusion criteria because of the following reasons: including the cases of smoking cessation failures (n = 31), cross-sectional studies (n = 11), not reporting the lipid profiles (n = 10), not reporting the changes in lipid profiles (n = 3), not reporting the changes in smoking status (n = 3), the study for smokeless tobacco users (n = 1), the study for nonsmoker (n =

Discussion

This meta-analysis showed that the level of HDL-C significantly elevated after cigarette smoking cessation. This result is fairly consistent since most of HDL-C cohorts (19/29) showed significant elevation. In contrast to HDL-C, TC, LDL-C, and TG did not show a significant change after cigarette smoking cessation.

Gordon et al. summarized prospective studies on risk factors for coronary heart disease (CHD) and estimated that 1 mg/dl increase in HDL-C after adjustment for other coronary risk

Conclusion

This meta-analysis showed that cigarette smoking cessation increases the level of HDL-C but not of TC, LDL-C, and TG. We should take into account the beneficial effect of HDL-C elevation after cigarette smoking cessation when we estimate their benefits.

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Regular articleThe effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a meta-analysis

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Initial search and preliminary selection (Fig. 1; Table 1)

Discussion

Conclusion

Am Heart J

Am Heart J

Atherosclerosis

Atherosclerosis

Am J Clin Nutr

Atherosclerosis

Atherosclerosis

Prev Med

Pathology

Prev Med

Am J Med

J Clin Epidemiol

Metabolism

Prev Med

J Clin Epidemiol

Control Clin Trials

Smoking and cardiovascular disease

Am J Med

Cigarette smoking and serum lipid and lipoprotein concentrationsan analysis of published data

BMJ

Regular article
The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: a meta-analysis