Abstract Body (Do not enter title and authors here): Background and Aims: Cigarette smoking is a known contributor to cardiovascular disease (CVD) and is associated with increased prevalence of coronary artery calcium. However, despite this clinical significance, calcium deposition in other vascular beds, specifically the aortic arch, has yet to be thoroughly investigated among cigarette smokers.

Methods: The study population comprised 3026 participants who underwent non-contrast chest CT scans in MESA exam 5. Aortic arch calcium (AAC) is defined as calcification in the transverse aortic arch, as measured using the Agatston method on chest CT scans. Log-transformed AAC scores were used for all analyses. Multivariate linear regression models were fit to assess the relationship between log-AAC and cigarette smoking status (never-smoked, former smoker, current smoker). Cox proportional hazard models were fit to investigate the relationship between log-AAC and incident CVD and mortality for those with a history of smoking (former & current smokers). All models were adjusted for demographic and traditional clinical risk factors.

Results: After excluding those with missing variables, 2196 participants were included in the final analysis, of which 1119 self-identified as never smokers, 901 as former smokers, and 176 as current smokers. Estimated mean log-AAC was 0.557 (p<0.001) log-Agatston units higher in former smokers compared with never smokers [95% CI: 0.374 - 0.741], and 1.030 (p<0.001) log-Agatston units higher in current smokers compared with never smokers [95% CI: 0.703 - 1.358]. Among ever-smokers (current or former smokers), a one log-Agatston unit increase in log-AAC was associated with a 20.6% (p = 0.002) increased risk for CVD events [95% CI: 7.4% - 35.5%] and a 12% (p = 0.020) increased risk for mortality [95% CI: 2% - 23%].

Conclusion: This study demonstrated a potential association between cigarette smoking and AAC scores, with significant differences in AAC among current, former, and never smokers. Furthermore, AAC is associated with incident cardiovascular events and mortality among those with a history of smoking.