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Smoking's Impact on LDL-C and ApoB Levels and the Path to Cessation

Updated: Apr 3


Smoking has long been known for its detrimental effects on respiratory health, but its influence on cardiovascular risk factors, particularly lipid profiles like low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (ApoB), is equally concerning. This article delves into these impacts, supported by recent scientific studies, and explores the benefits of smoking cessation.

The synergy between smoking, elevated ApoB, and high LDL-C levels significantly increases the risk of coronary heart disease. The robust evidence supporting the superior predictive power of ApoB over LDL-C for cardiovascular risk, combined with the amplified risk of  atherosclerotic cardiovascular disease (ASCVD) in smokers with high LDL-C, underscores the urgent need for targeted interventions in these high-risk groups. These findings emphasize the importance of comprehensive risk assessments in smokers, considering both ApoB and LDL-C levels to accurately gauge and mitigate cardiovascular risks.

Smoking and LDL-C: Increasing the Odds of Heart Disease

The relationship between smoking, LDL-C levels, and ASCVD has been extensively studied. A study published in "Circulation Journal" explored this association, particularly focusing on whether smoking's impact on CHD varies with LDL-C levels. The study followed 13,410 middle-aged adults initially free of stroke and ASCVD over 13.3 years, during which there were 932 incident CHD events. The findings indicated that both smoking and increased LDL-C were risk factors for CHD. Unsurprisingly, the relative hazard (RH) of ASCVD in relation to smoking was larger among those with higher LDL-C levels compared to those with lower levels. This suggests a positive multiplicative interaction between smoking and LDL-C for ASCVD incidence​​.

A similar multiplicative effect in a genetics study of almost 2000 individuals that associated the genes that induce smoking and the genes that induce high ApoB, even in those with low LDL-C. 

Smoking May Have Direct Effects on Plaque-Causing Lipids

The Impact on LDL-C and HDL-C

A study of nearly 35,000 men and women found that smokers have a 10-15% higher LDL-C level compared to non-smokers along with elevated triglycerides. Elevated LDL-C is a critical risk factor in the development of atherosclerosis.

A study titled "Influence of smoking on serum lipid and lipoprotein levels among family medicine patients" found that smoking leads to an increase in total cholesterol, triglycerides, and LDL-C levels, while simultaneously decreasing HDL-C (high-density lipoprotein cholesterol) levels. This imbalance enhances the risk for cardiovascular diseases. Smokers had significantly higher serum total cholesterol, triglycerides, and LDL-C levels, and lower HDL-C levels compared to non-smokers​​.

ApoB Levels in Smokers

A large study of elderly Chinese men found that smokers were 3-24X more likely to have elevated ApoB levels depending on their level of smoking compared to non-smokers. 

A meta-analysis "Smoking and apolipoprotein levels: A meta-analysis of published data" by Alba Romero Kauss et al. confirmed that smoking is associated with increased levels of ApoB, a critical component of LDL particles involved in arterial plaque formation. This study reinforced the negative impact of smoking on lipid metabolism and its contribution to heightened cardiovascular risk​​.

Smoking Cessation and Lipid Profiles

Effects on HDL-C and LDL-C

Research demonstrates that quitting smoking can improve lipid profiles. A randomized clinical trial found that although smoking cessation did not significantly change LDL-C levels, it positively affected HDL-C levels. Abstainers showed increases in HDL-C compared to those who continued smoking, indicating a reduction in cardiovascular disease risk despite potential weight gain​​.

Impact on ApoB Levels

The effects of smoking cessation on ApoB levels are less clear, with insufficient data available for a comprehensive analysis. However, the established link between smoking, ApoB levels, and cardiovascular risk suggests that cessation might positively influence ApoB levels as well​​.

Smoking Cessation Interventions

Nicotine Replacement Therapy

A study titled "A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy" by Hajek et al. in the "New England Journal of Medicine" found that e-cigarettes were more effective for smoking cessation than traditional nicotine-replacement therapy when combined with behavioral support. The study reported a higher one-year abstinence rate in the e-cigarette group compared to the nicotine-replacement group​​.

Behavioral Interventions

Behavioral interventions play a crucial role in smoking cessation. The study "Behavioural interventions for smoking cessation: an overview and network meta-analysis" by Jamie Hartmann-Boyce et al. found that behavioral support, especially when combined with counseling and financial incentives, can significantly increase quit rates at six months or longer​​.


Smoking's impact on lipid profiles, particularly on LDL-C and ApoB levels, is a significant contributor to cardiovascular risks. Smoking cessation, supported by nicotine replacement therapies and behavioral interventions, not only reverses some of these adverse effects but also contributes to overall cardiovascular health improvement. This information is vital for individuals looking to make informed decisions about their health and lifestyle choices.


  1. Hozawa, A., Folsom, A. R., Sharrett, A. R., Payne, T. J. & Chambless, L. E. Does the impact of smoking on coronary heart disease differ by low-density lipoprotein cholesterol level?: the Atherosclerosis Risk in Communities (ARIC) Study. Circ. J. 70, 1105–1110 (2006)

  2. Roy, N., Gaudet, D., Tremblay, G. & Brisson, D. Association of common gene-smoking interactions with elevated plasma apolipoprotein B concentration. Lipids Health Dis. 19, 98 (2020)

  3. Nakamura, M. et al. “Relationships between Smoking Status, Cardiovascular Risk Factors, and Lipoproteins in a Large Japanese Population.” J. Atheroscler. Thromb. 28, 942–953 (2021)

  4. "Influence of smoking on serum lipid and lipoprotein levels among family medicine patients," PubMed, 2022.

  5. Tan, X. J. et al. Relationship between smoking and dyslipidemia in western Chinese elderly males. J. Clin. Lab. Anal. 22, 159–163 (2008)

  6. Alba Romero Kauss et al., "Smoking and apolipoprotein levels: A meta-analysis of published data," Toxicol Rep, 2022.

  7. "Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial," PubMed, 2019.

  8. Hajek P, et al., "A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy," N Engl J Med, 2019.

  9. Jamie Hartmann-Boyce et al., "Behavioural interventions for smoking cessation: an overview and network meta-analysis," Cochrane Database Syst Rev, 2021.

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