['452°', '‘', 'review', 'by', 'the', 'Surgeon', 'General', 'in', '1964', 'led', 'to', 'his', 'report', 'on', 'the', 'health', 'hazards', 'of', 'smoking', 'and', 'to', 'the', 'conclusion', 'that', 'male', 'cigarette', 'smokers', 'have', 'higher', 'death', 'rates', 'from', 'CHD', 'than', 'do', 'male', 'nonsmokers', '[1].', 'It', 'was', 'not', 'clear,', 'however,', 'that', 'the', 'relationship', 'had', '“causal', 'significance”.', 'Evidence', 'for', 'a', 'causal', 'relationship', 'between', 'cigarette', 'smoking', 'and', 'coronary', 'heart', 'disease', 'was', 'presented', 'by', 'Doll', 'and', 'Hill', '[2],', 'and', 'the', '1967', 'Public', 'Health', 'Service', 'review', '[3]', 'suggested', 'that', 'the', 'high', 'death', 'rate', 'from', 'CHD', 'in', 'smokers', 'may', 'be', 'caused', 'by', 'cigarette', 'smoking.', 'Since', '1964,', 'the', 'Public', 'Health', 'Service', 'has', 'published', '6', 'scientific', 'reviews', 'of', 'major', 'studies', 'relating', 'to', 'cigarette', 'usage,', 'and', 'each', 'review', 'has', 'provided', 'corrob-', 'orating', 'evidence', 'linking', 'cigarette', 'smoking', 'to', 'disease', 'and', 'early', 'death.', 'The', '1973', 'report', 'stated', 'unequivocally', 'that', 'in', 'the', 'United', 'States,', 'CHD', 'is', 'the', 'leading', 'cause', 'of', 'death', 'and', '“is', 'the', 'largest', 'contributor', 'to', 'the', 'excess', 'deaths', 'among', 'cigarette', 'smokers', '[1].', 'Possible', 'injurious', 'mechanisms', 'of', 'cigarette', 'smoking', 'for', 'the', 'cardiovascular', 'system', 'have', 'been', 'summarized', '[4]', 'and', 'include', 'formation', 'of', 'significant', 'levels', 'of', 'carboxyhemoglobin,', 'release', 'of', 'catecholamines,', 'inadequate', 'myocardial', 'oxy-', 'genation,', 'and', 'an', 'increase', 'in', 'platelet', 'adhesiveness', 'which', 'might', 'contribute', 'to', 'acute', 'thrombus', 'formation.', 'In', 'addition,', 'cigarette', 'smoke', 'is', 'the', 'major', 'source', 'for', 'the', 'accumulation', 'of', 'cadmium', 'in', 'the', 'human', 'body', '[5—7],', 'and', 'there', 'is', 'evidence', 'for', 'a', 'correlation', 'between', 'cadmium/zinc', 'ratio', 'in', 'kidney', 'and', 'liver', 'and', 'the', 'ex-', 'tent', 'of', 'atherosclerosis', '[8].', 'Schroeder', 'and', 'Kraemer', 'have', 'suggested', 'that', 'cad-', 'mium', 'might', 'be', 'responsible', 'for', 'bringing', 'about', 'an', 'increase', 'in', 'cardiovascular', 'mortality', '[9].', 'Few', 'investigators', 'have', 'specifically', 'desizned', 'their', 'studies', 'to', 'answer', 'questions', 'dealing', 'with', 'the', 'association', 'between', 'cigarette', 'smoking', 'habits', 'and', 'the', 'develop-', 'ment', 'of', 'atherosclerotic', 'lesions', 'in', 'the', 'aorta', 'and', 'coronary', 'arteries.', 'Auerbach', 'et', 'al,', 'in', 'an', 'autopsy', 'study', '{10]', 'found', 'more', 'coronary', 'atherosclerosis', 'in', 'smokers', 'than', 'in', 'nonsmokers,', 'and', 'found', 'also', 'that', 'the', 'amount', 'of', 'atherosclerosis', 'in-', 'creased', 'with', 'the', 'amount', 'of', 'cigarette', 'smoking.', 'In', 'another', 'autopsy', 'study,', 'Wilens', 'and', 'Plair', '(11]', 'found', 'significantly', 'more', 'severe', 'sclerosis', 'of', 'the', 'aorta', 'in', 'cigarette', 'smokers', 'than', 'in', 'nonsmokers;', 'they', 'did', 'not', 'evaluate', 'coronary', 'artery', 'lesions.', 'Sackett', 'and', 'Winklestein', '[12]', 'reported', 'that', 'elderly', 'cigarette', 'smokers', 'had', 'significantly', 'higher', 'rates', 'of', 'aortic', 'calcification', 'on', 'chest', 'X-rays', 'than', 'non-', 'smokers,', 'Sackett', 'et', 'al.', '[13]', 'in', 'an', 'autopsy', 'study', 'found', 'a', 'significant', 'relation-', 'ship', 'between', 'the', 'use', 'of', 'cigarettes', 'and', 'severity', 'of', 'aortic', 'atherosclerosis.', 'This', 'report', 'deals', 'with', 'the', 'relationship', 'of', 'cigarette', 'smoking', 'to', 'atherosclero-', 'tic', 'lesions', 'in', 'the', 'aorta', 'and', 'coronary', 'arteries', 'of', 'autopsied', 'men.', 'In', 'evaluating', 'arterial', 'lesions', 'and', 'in', 'assessing', 'smoking', 'habits,', 'we', 'have', 'attempted', 'to', 'reduce', 'some', 'of', 'the', 'more', 'obvious', 'sources', 'of', 'bias.', 'Pathologists', 'have', 'estimated', 'extent', 'and', 'severity', 'of', 'lesions', 'in', 'the', 'artery', 'specimens', 'without', 'having', 'krowledge', 'of', 'the', 'demographic,', 'clinical', 'or', 'necropsy', 'information', 'pertaining', 'to', 'the', 'patients.', 'In', 'addition,', 'an', 'objective', 'method', 'of', 'evaluating', 'arterial', 'lesions', 'was', 'used', 'in', 'which', 'a', 'soft', 'X-ray', 'radiographic', 'image', 'of', 'the', 'specimen', 'was', 'analyzed', 'with', 'a', 'scanning', 'device', '(14].', 'Staff', 'research', 'interviewers', 'who', 'obtained', 'the', 'smoking', 'histories', 'and', 'other', 'environmental', 'data', 'had', 'no', 'knowledge', 'of', 'the', 'extent', 'of', 'atherosclero-', 'zic', 'lesions', 'prior', 'to', 'interview', 'of', 'next', 'of', 'kin.', 'Tests', 'of', 'methods', 'for', 'collecting', 'the', 'smoking', 'information', 'had', 'been', 'conducted', 'in', 'order', 'co', 'determine', 'whether', 'reii-', 'Seé6LOesose']