A study published online Feb. 9 in the European Heart Journal (Eur Heart J) showed that in people without known coronary artery disease (CAD), atherosclerotic load was increased in both current and former smokers compared with never smokers; however, only current smokers had an increased risk of all-cause death or nonfatal myocardial infarction (MACE), while no such increased risk was seen in former smokers. This elevated risk was not seen in former smokers. The study included 9456 patients with no known CAD, 5685 never smokers, 1588 current and 2183 former smokers (who had quit smoking ≥3 months prior to coronary CT imaging), respectively. After correcting for risk with a Cox proportional risk model, the relationship between smoking status and MACE was assessed in subjects. The investigators further assessed risk in subjects with similar age, sex, CAD risk factors and clinical presentation after propensity matching in a 1:1:1 ratio. The results showed a total of 297 MACE events during a mean follow-up of 2.8 ± 1.9 years. Current and former smokers had a higher atherosclerotic load (P< 0.0001) and a higher incidence of obstructive CAD compared with never smokers [single-vessel lesion (1-VD ): 10.6% vs. 14.9% vs. 15.2%, P< 0.001; two-vessel lesion (2-VD ): 4.4% vs. 6.1% vs. 6.2%, P= 0.001; 3-vessel lesion (3-VD ): 3.1% vs. 5.2% vs. 4.3%, P< 0.001)]. Current smokers had a higher risk of MACE compared with never smokers [hazard ratio (HR) HR 1.9, P< 0.001], but this elevated risk was not observed in former smokers (HR 1.2, P= 0.35). This correlation was similar in matched populations.