The high risk of cardiovascular events in smokers requires adequate control of other cardiovascular risk factors (CVRFs) to curtail atherosclerosis progression. However, it is unclear which CVRFs have the most influence on atherosclerosis progression in smokers. Methods: In 260 smokers aged 40-70 included in a smoking cessation trial, we analyzed the association between traditional CVRFs, high-sensitivity C reactive protein (hs-CRP), smoking cessation and 3-year progression of carotid

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... ia thickness (CIMT, assessed by repeated ultrasound measurements) in a longitudinal multivariate model. Results: Participants (mean age 52 years, 47% women) had a mean smoking duration of 32 years with a median daily consumption of 20 cigarettes. Baseline CIMT was 1185μm (95%CI:1082-1287) and increased by 93μm (95%CI:25-161) and 108μm (95%CI:33-183) after one and three years, respectively. Age, male sex, daily cigarette consumption, systolic blood pressure (SBP), but neither LDL-cholesterol nor hs-CRP, were independently associated with baseline CIMT (all p≤0.05). Baseline SBP, but neither LDL-cholesterol nor hs-CRP, was associated with 3-year atherosclerosis progression (p=0.01 at 3 years). The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. We found an increase of 26μm per each 10mmHg raise in SBP at one year and an increase of 39μm per each 10mmHg raise in SBP at three years. Due to insufficient statistical power, we could not exclude an effect of smoking abstinence on CIMT progression. Conclusion: 3 Control of blood pressure may be an important factor to limit atherosclerosis progression in smokers, besides support for smoking cessation. Implications Among 260 smokers aged 40-70 years with a mean smoking duration of 32 years, baseline systolic blood pressure was associated with atherosclerosis progression over 3 years, as measured by carotid intima-media thickness (CIMT, p=0.01 at 3 years), independently of smoking variables and other cardiovascular risk factors. The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. Our findings emphasize the importance of focusing not only on smoking cessation among smokers, but to simultaneously control other cardiovascular risk factors, particularly blood pressure, in order to prevent future cardiovascular disease.