Does smoking cigarettes cause high cholesterol?

Cholesterol is a primary causal risk factor for atherosclerotic cardiovascular disease (ASCVD), the leading cause of death globally.^1,2 Cigarette smoking is associated with increased total cholesterol, triglyceride, and low-density lipoprotein cholesterol (LDL-C) levels, and decreased high-density lipoprotein cholesterol (HDL-C), all of which are ASCVD causal risk factors.^2-7

The literature does not explicitly state that smoking causes high cholesterol, but that it can yield the aforementioned atherogenic lipid profile which, like high cholesterol, contributes to ASCVD risk.^2,3,7

Of this lipid profile, decreased HDL levels in particular are strongly associated with ASCVD risk in smokers.^2,5 The mechanism by which cigarette smoking alters lipid levels remains unclear. One mechanism may be changes in the three steps of HDL metabolism—HDL biosynthesis and maturation, intravascular remodeling of HDL, and HDL catabolism—and their associated enzymes and transfer proteins. Another is changes in catecholamine release, which alters very low-density lipoprotein, LDL-C, and HDL-C levels ^3,5,8,9

While there are many contributing factors that lead to the development of ASCVD, smoking is one of the strongest modifiable risk factors. In addition to potentially altering cholesterol and triglyceride levels, it also causes the narrowing and stiffening of blood vessels, increases plaque buildup in blood vessels, and makes blood more likely to clot. All these effects can lead to heart disease and stroke.¹⁰

References

1. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2019;140(11):e596-e646.
2. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. 2019;139(10):e56-e528.
3. Gepner AD, Piper ME, Johnson HM, et al. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J. 2011;161(1):145-151.
4. Jain RB, Ducatman A. Associations between smoking and lipid/lipoprotein concentrations among US adults aged ≥20 years. J Circ Biomark. 2018;7:1849454418779310.
5. He BM, Zhao SP, Peng ZY. Effects of cigarette smoking on HDL quantity and function: implications for atherosclerosis. J Cell Biochem. 2013;114(11):2431-2436.
6. Gossett LK, Johnson HM, Piper ME, et al. Smoking Intensity and Lipoprotein Abnormalities in Active Smokers. J Clin Lipidol. 2009;3(6):372-378.
7. Rao Ch S, Subash YE. The Effect of Chronic Tobacco Smoking and Chewing on the Lipid Profile. J Clin Diagn Res. 2013;7(1):31-34.
8. Chadwick AC, Holme RL, Chen Y, et al. Acrolein impairs the cholesterol transport functions of high density lipoproteins. PLoS One. 2015;10(4):e0123138
9. Forey BA, Fry JS, Lee PN, et al. The effect of quitting smoking on HDL-cholesterol - a review based on within-subject changes. Biomark Res. 2013;1(1):26.