Abstract
CLINICAL ISSUE: Smoking, which affects the whole cardiovascular system, primarily results in atheromatous plaques with risk of vascular stenosis or aneurysmatic vascular changes with risk of rupture. STANDARD RADIOLOGICAL METHODS: Depending on location, sonography provides an initial assessment of alterations. Angiography in combination with computed tomography (CT) and magnetic resonance imaging (MRI) allows further evaluation and, if necessary, therapy planning. In smokers without clinical symptoms or additional risk factors, imaging only because of smoking is not recommended. METHODICAL INNOVATIONS: Recent guidelines of respective pathologies unanimously acknowledge smoking as modifiable risk factor for cardiovascular diseases; therefore, smoking cessation for prevention of secondary acute events is always recommended as the first step. In suspected chronic coronary syndrome, smoking increases clinical probability, which means that diagnostic imaging is often indicated earlier. PERFORMANCE: Although smoking causes extensive changes to the entire cardiovascular system, it remains to be evaluated whether smokers might profit from modification of current guidelines regarding prevention and diagnosis in terms of specific clinical events. PRACTICAL RECOMMENDATIONS: Due to increased cardiovascular risk, smokers should be advised to stop smoking. Regarding specific diseases, smoking does not fundamentally result in modification of imaging evaluation; however, in intermediate risk patients, further imaging can be recommended earlier in smokers.