Association between Cigarette Smoking and Angina Pectoris Among Middle-Aged Adults: Findings from the Framingham Cohort Study

Objectives: This study investigates the relationship between current cigarette smoking at baseline and the occurrence of angina pectoris during follow-up among middle-aged adults (30-70 years), adjusting for age, sex, BMI, diabetes status, education, and number of cigarettes smoked per day. Methods: Using the Framingham Heart Study cohort (N=4,434), logistic regression analyses were performed. A backward selection approach identified confounders and explored effect modification. Results: Angina prevalence was 16.4%, with higher odds observed in males, older individuals, and those with obesity or diabetes. Smoking status showed a non-significant association with angina in multivariable models (aOR:0.86, 95% CI: 0.73-1.01). However, age and BMI remained significant predictors, with older age (60-70 years) (aOR: 2.26, 95% CI:1.63-3.12) and obesity (aOR: 1.77, 95% CI: 1.38-2.27) increasing the risk of angina. Conclusions: While smoking status was not significantly associated with angina after adjustment, the findings highlight the role of age and BMI in angina risk. Targeted interventions addressing these factors may help reduce the burden of angina pectoris in middle-aged adults.