impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants background current smokers have an increased cardiovascular disease cvd risk compared to exsmokers due to reversible as well as irreversible effects of smoking we investigated if current smokers remain to have an increased cvd risk compared to exsmokers in subjects with a long and intense smoking history we in addition studied if the effect of smoking continuation on cvd risk is independent of or modified by the presence of cardiovascular calcificationsmethods the cohort used comprised a sample of 3559 male lung cancer screening trial participants we conducted a casecohort study using all cvd cases and a random sample of 10 n341 from the baseline cohort subcohort a weighted cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to cvd eventsresults during a median followup of 26 years max 37 years 263 fatal and nonfatal cardiovascular events cases were identified age packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 133 95 confidence interval 100177 in additional analyses that incorporated multiplicative interaction terms neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk p008conclusions current smokers have an increased cvd risk compared to former smokers even in subjects with a long and intense smoking history smoking exerts its hazardous effects on cvd risk by pathways partly independent of cardiovascular calcifications