Aortic calcification and smoking: location and imaging modality matter, new data show
A new meta-analysis is offering updated insight into associations between cigarette smoking and aortic calcification, with a couple of key findings having potential implications for future research.
Researchers analyzed 12 studies involving nearly 150,000 participants, including almost 50,000 current smokers, to examine whether smoking was associated with aortic calcification and whether factors such as age, sex, aortic segment and imaging modality influenced the relationship. Their findings suggest that cigarette smoking does not necessarily significantly impact aortic calcification overall, but that it does appear to affect one area specifically more so than others—the abdominal aorta. The team also emphasized that imaging modality plays a key role, with CT offering the most detailed assessment of aortic calcification.
The team believes their work helps bring clarity to prior research on the topic.
“Several population-based studies have reported associations between current smoking and extra-coronary calcification, including the aortic arch, thoracic aorta, and abdominal aorta,” Hussein Nafakhi, with the department of internal medicine at the University of Kufa in Iraq, and colleagues noted. “However, the magnitude and consistency of these associations have varied across populations, imaging modalities, and anatomical regions, with some studies reporting significant associations and others finding little or no relationship after adjustment for conventional cardiovascular risk factors. Despite these findings, important uncertainties remain in the literature.”
The systematic review included studies identified through a search of the medical literature from database inception through mid-November 2025. Most studies were community-based and used CT to evaluate thoracic or abdominal aortic calcification.
Across all studies, current smoking was associated with a nonsignificant trend toward greater odds of aortic calcification. Overall, an estimated 37.8% of current smokers had detectable aortic calcification.
However, these results became more notable when researchers examined specific subgroups; among studies using CT, current smoking was significantly associated with aortic calcification, with an odds ratio of 1.44. Segment-specific analysis also found a significant association between smoking and abdominal aortic calcification, while the association with thoracic aortic calcification was borderline.
Age appeared to play a role as well. Among adults aged 60 years or older, current smoking was associated with higher odds of aortic calcification, although the link fell just short of statistical significance.
Though the findings warrant additional consideration, the authors emphasized that they should be considered exploratory. They do, however, highlight the potential value of considering where calcification is measured and how it is detected when evaluating smoking-related vascular changes. The group suggested that future work could build on their findings by using standardized imaging protocols and being prospective in nature.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.