ESC Congress 2026 Abstract · Oct 26, 2026
Cigarette smoking exacerbates aortic elastic properties and increase carotid thickness in hypertensive males with higher non-HDL-C
By Ioakeimidis N, Georgousi E, Terentes-Printzios D et al.
Background: The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is frequent in hypertensive patients and it is an independent risk factor for the prevalence of hypertension. Aim of this study was to explore whether smoking and elevated non-HDL exert a synergistic effect on functional and structural parameters of large arteries in hypertensive patients. Methods: Carotid-femoral pulse wave velocity (cf PWV) and carotid intima media thickness (cIMT) were measured in two age and BP-matched groups without manifest atherosclerotic cardiovascular diseases (ASCVD): 159 smokers and 108 never smokers with hypertension. Non-HDL-C was determined in all patients by subtracting HDL cholesterol from total cholesterol. Levels at or above 160 mg/dL are considered high. Results: In multivariate regression analysis non-HDL-C was independently associated with cf PWV in (b=0.27, P<0.05) and c IMT (b=0.34, P<0.01). Thecorrelation of cfPWV with non-HDL-C was not statistically significant in never smokers patients (all P>0.05). 94 (59 %) smokers and 58 (54%) never smokers had non-HDL-C levels above 160 mg/dl. The two groups were divided into subgroups according to presence/absence of high non-HDL level. The subgroups of smokers and never smokers with high non-HDL-C had significantly higher systolic BP compared to subjects with lower non-HDL-C (all P<0.05). Αge, body mass index, fasting glucose, C-reactive protein and total testosterone levels did not significantly change among subgroups. The prevalence of subjects under statin and antihypertensive therapy was not different. The cumulative tobacco exposure (measured in pack-years) was similar between the two non-HDL-C subgoups (40 pack-years). Figure shows cfPWV and cIMT of smokers and never smokers in relation to non-HDL-C level. Smokers with non-HDL-C>160 mg/dl had significantly higher cfPWV and cIMT compared to the three other subgroups (P<0.01 and P<0.001, respectively by ANOVA). cfPWV and cIMT were not different between smokers with non-HDL-C below 160 mg /dl and never smokers with high non-HDL-C. The differences in cfPWV and cIMT measurements remained statistically significant after adjustment for systolic BP. Conclusions: Aortic stiffness and carotid wall thickness are positively correlated with non-HDL-C levels in hypertensive smokers while in never smokers the association was not significant. The study also shows that high non-HDL-C level combined with smoking have a detrimental effect on carotid IMT and aortic PWV. Considering the predictive value of aortic stiffness and carotid thickness in arterial hypertension, the finding of this study imply interrelationships between an excess of atherogenic lipoproteins, tobacco cigarette smoke, regarding changes in arterial wall properties.IMT and PWV based on smoking and non-HDL-C