Bond MG, Barnes RW, Riley WA, et al. J Neuroimaging . O'Leary DH, Polak JF, Wolfson SK Jr, et al. Use of sonography to evaluate carotid atherosclerosis in the elderly. We agree with Dr Duenas that the impact of diabetes on the relationship between smoking and atherosclerosis requires further investigation.
Similar concerns exist for the amplified harmful effects of smoking among people with hypertension.
It is not surprising that Dr Smith and Ogden, scientists representing the tobacco industry, have chosen to criticize this report. They discuss selected pathways for the harmful effects of smoking, but fail to provide a comprehensive account. There are numerous other mechanisms for the harmful effects of smoking, for example, damage to the endothelial layer of the arterial wall with effects that persist after smoking cessation and continue to underline progression of atherosclerosis. They are incorrect that we found no dose-response relationship for active smoking. In addition, they suggest that the absence of a dose-response relationship for ETS implies the absence of an association.