Interactions between smoking, pulmonary surfactant protein b, and atherosclerosis in the general population: The dallas heart study

Ann B. Nguyen, Anand K Rohatgi, Christine K Garcia, Colby R. Ayers, Sandeep R Das, Susan G. Lakoski, Jarett D Berry, Amit Khera, Darren K McGuire, James A de Lemos

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective-: Pulmonary surfactant protein B (SP-B), an alveolar protein normally detectable at only very low concentrations in blood, circulates at higher levels among smokers and those with alveolar injury and inflammation. We hypothesized that SP-B may serve as a marker of the vascular effects of smoking and would thus be associated with subclinical measures of atherosclerosis. Methods and results-: Plasma levels of SP-B were measured in 3294 subjects, ages 30 to 65, enrolled in the Dallas Heart Study, a probability-based population sample of Dallas County adults. Coronary artery calcium (CAC) was measured by computed tomography and abdominal aortic plaque (AP) by magnetic resonance imaging. The cohort comprised 29% current and 17% former smokers. The overall prevalence of CAC was 22%, and that of AP was 39%. Median SP-B levels were 5-fold higher among current versus never smokers (P<0.0001) and were significantly correlated with estimated pack-years smoked (Spearman ρ=0.35, P<0.0001). Increasing levels of SP-B also associated with other traditional cardiac risk factors and higher levels of inflammatory biomarkers. In univariable analyses, increasing SP-B quartiles associated with higher prevalence of both CAC and AP (Ptrend<0.0001 for each). In multivariable analyses adjusting for traditional cardiovascular risk factors, SP-B remained associated with AP (OR 1.87 for the 4th versus 1st quartiles, 95% confidence interval 1.39 to 2.51; P<0.0001) but not CAC. An interaction was observed between SP-B, smoking status, and AP (Pinteraction=0.01), such that SP-B associated with AP in current smokers (adjusted OR 2.15 for the 4th versus 1st quartile, 95% confidence interval 1.26 to 3.67; P=0.005) but not in former or never smokers. Conclusion-: Circulating levels of SP-B increase with greater smoking burden and independently associate with abdominal AP among current smokers. Our findings support further investigation of the role of SP-B as a marker of the vascular effects of smoking.

Original languageEnglish (US)
Pages (from-to)2136-2143
Number of pages8
JournalArteriosclerosis, thrombosis, and vascular biology
Issue number9
StatePublished - Sep 2011


  • atherosclerosis
  • peripheral arterial disease
  • smoking

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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