---
title: "Nicotine metabolism (NMR) and myocardial infarction risk in people with HIV who smoke"
id: "pubmed-42611874"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42611874"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42611874/"
doi: "10.1371/journal.pone.0356296"
published_at: "2026-08-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nicotine metabolism (NMR) and myocardial infarction risk in people with HIV who smoke
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42611874
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42611874/)
- **DOI:** [10.1371/journal.pone.0356296](https://doi.org/10.1371%2Fjournal.pone.0356296)
- **Published At:** 2026-08-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Cigarette smoking prevalence among **people with HIV (PWH)** is 2–3 times higher than in the general population, and smoking elevates risk of **myocardial infarction (MI)**. - The **nicotine metabolite ratio (NMR)** quantifies rate of nicotine metabolism; faster metabolism links to greater nicotine dependence and higher lung cancer risk in other populations. - This study used a nested case-control design within the CNICS cohort to evaluate whether NMR is associated with incident, adjudicated MI among PWH who smoke. - Cases were PWH reporting cigarette use who experienced adjudicated MI between 2003 and 2020 and had available plasma samples; controls were cigarette-smoking PWH matched by incidence density sampling on age, race, birth sex, and plasma HIV RNA level. - Conditional logistic regression was planned to estimate odds ratios (ORs) for the association between **NMR** and MI. - The abstract reports that the investigators identified 135 cases but the source text is truncated and does not include the full results, effect estimates, or conclusions. - Key study metadata available: PLoS One, 2026; PMID 42611874; DOI 10.1371/journal.pone.0356296; multiple US and Canadian academic coauthors and institutions. - Details not reported in the available source text include the final sample size for controls, the distribution of NMR, adjusted ORs, statistical significance, sensitivity analyses, and the authors’ conclusions and clinical implications. - Because primary outcome data are missing from the provided source text, no definitive statements about the association between **NMR** and **MI** in PWH who smoke can be drawn from this document alone.
## Clinical Analysis & Structured Key Points
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Rate of nicotine metabolism on risk of myocardial infarction among people with HIV who smoke cigarettes [Derartu Ahmed](https://pubmed.ncbi.nlm.nih.gov/?term=Ahmed+D&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Warren B Bilker](https://pubmed.ncbi.nlm.nih.gov/?term=Bilker+WB&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Xiaoyan Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+X&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Rachel F Tyndale](https://pubmed.ncbi.nlm.nih.gov/?term=Tyndale+RF&cauthor_id=42611874)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-2 "University of Toronto, Department of Pharmacology and Toxicology, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-3 "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Ontario, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-4 "University of Toronto, Department of Psychiatry, Ontario, Canada."), [Jessica Merlin](https://pubmed.ncbi.nlm.nih.gov/?term=Merlin+J&cauthor_id=42611874)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-5 "University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America."), [Stephen E Kimmel](https://pubmed.ncbi.nlm.nih.gov/?term=Kimmel+SE&cauthor_id=42611874)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-6 "University of Florida, Department of Epidemiology, GainesvilleFlorida, United States of America."), [Jeffrey Martin](https://pubmed.ncbi.nlm.nih.gov/?term=Martin+J&cauthor_id=42611874)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-7 "University of California San Francisco, San Francisco, California, United States of America."), [Michael Plankey](https://pubmed.ncbi.nlm.nih.gov/?term=Plankey+M&cauthor_id=42611874)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-8 "Georgetown Medical Center, Department of Medicine, Washington, District of Columbia, United States of America."), [Katerina Christopoulos](https://pubmed.ncbi.nlm.nih.gov/?term=Christopoulos+K&cauthor_id=42611874)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-7 "University of California San Francisco, San Francisco, California, United States of America."), [Leila S Hojat](https://pubmed.ncbi.nlm.nih.gov/?term=Hojat+LS&cauthor_id=42611874)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-9 "Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America."), [Laura Bamford](https://pubmed.ncbi.nlm.nih.gov/?term=Bamford+L&cauthor_id=42611874)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-10 "University of California San Diego School of Medicine, San Diego, California, United States of America."), [Sonia Napravnik](https://pubmed.ncbi.nlm.nih.gov/?term=Napravnik+S&cauthor_id=42611874)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-11 "University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, United States of America."), [Robert Schnoll](https://pubmed.ncbi.nlm.nih.gov/?term=Schnoll+R&cauthor_id=42611874)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-12 "University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania, United States of America."), [Rebecca Ashare](https://pubmed.ncbi.nlm.nih.gov/?term=Ashare+R&cauthor_id=42611874)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-13 "The State University of New York, Department of Psychology, Buffalo, New York, United States of America."), [Robert Gross](https://pubmed.ncbi.nlm.nih.gov/?term=Gross+R&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#full-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America.") Affiliations Expand ### Affiliations * 1 University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America. * 2 University of Toronto, Department of Pharmacology and Toxicology, Ontario, Canada. * 3 Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Ontario, Canada. * 4 University of Toronto, Department of Psychiatry, Ontario, Canada. * 5 University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. * 6 University of Florida, Department of Epidemiology, GainesvilleFlorida, United States of America. * 7 University of California San Francisco, San Francisco, California, United States of America. * 8 Georgetown Medical Center, Department of Medicine, Washington, District of Columbia, United States of America. * 9 Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America. * 10 University of California San Diego School of Medicine, San Diego, California, United States of America. * 11 University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, United States of America. * 12 University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania, United States of America. * 13 The State University of New York, Department of Psychology, Buffalo, New York, United States of America. * PMID: **42611874** * DOI: [ 10.1371/journal.pone.0356296 ](https://doi.org/10.1371/journal.pone.0356296) Item in Clipboard # Rate of nicotine metabolism on risk of myocardial infarction among people with HIV who smoke cigarettes Derartu Ahmed et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42611874/) . 2026 Aug 18;21(8):e0356296. doi: 10.1371/journal.pone.0356296. eCollection 2026. ### Authors [Derartu Ahmed](https://pubmed.ncbi.nlm.nih.gov/?term=Ahmed+D&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Warren B Bilker](https://pubmed.ncbi.nlm.nih.gov/?term=Bilker+WB&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Xiaoyan Han](https://pubmed.ncbi.nlm.nih.gov/?term=Han+X&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America."), [Rachel F Tyndale](https://pubmed.ncbi.nlm.nih.gov/?term=Tyndale+RF&cauthor_id=42611874)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-2 "University of Toronto, Department of Pharmacology and Toxicology, Ontario, Canada.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-3 "Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Ontario, Canada.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-4 "University of Toronto, Department of Psychiatry, Ontario, Canada."), [Jessica Merlin](https://pubmed.ncbi.nlm.nih.gov/?term=Merlin+J&cauthor_id=42611874)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-5 "University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America."), [Stephen E Kimmel](https://pubmed.ncbi.nlm.nih.gov/?term=Kimmel+SE&cauthor_id=42611874)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-6 "University of Florida, Department of Epidemiology, GainesvilleFlorida, United States of America."), [Jeffrey Martin](https://pubmed.ncbi.nlm.nih.gov/?term=Martin+J&cauthor_id=42611874)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-7 "University of California San Francisco, San Francisco, California, United States of America."), [Michael Plankey](https://pubmed.ncbi.nlm.nih.gov/?term=Plankey+M&cauthor_id=42611874)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-8 "Georgetown Medical Center, Department of Medicine, Washington, District of Columbia, United States of America."), [Katerina Christopoulos](https://pubmed.ncbi.nlm.nih.gov/?term=Christopoulos+K&cauthor_id=42611874)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-7 "University of California San Francisco, San Francisco, California, United States of America."), [Leila S Hojat](https://pubmed.ncbi.nlm.nih.gov/?term=Hojat+LS&cauthor_id=42611874)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-9 "Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America."), [Laura Bamford](https://pubmed.ncbi.nlm.nih.gov/?term=Bamford+L&cauthor_id=42611874)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-10 "University of California San Diego School of Medicine, San Diego, California, United States of America."), [Sonia Napravnik](https://pubmed.ncbi.nlm.nih.gov/?term=Napravnik+S&cauthor_id=42611874)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-11 "University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, United States of America."), [Robert Schnoll](https://pubmed.ncbi.nlm.nih.gov/?term=Schnoll+R&cauthor_id=42611874)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-12 "University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania, United States of America."), [Rebecca Ashare](https://pubmed.ncbi.nlm.nih.gov/?term=Ashare+R&cauthor_id=42611874)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-13 "The State University of New York, Department of Psychology, Buffalo, New York, United States of America."), [Robert Gross](https://pubmed.ncbi.nlm.nih.gov/?term=Gross+R&cauthor_id=42611874)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42611874/#short-view-affiliation-1 "University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America.") ### Affiliations * 1 University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, Pennsylvania, United States of America. * 2 University of Toronto, Department of Pharmacology and Toxicology, Ontario, Canada. * 3 Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Ontario, Canada. * 4 University of Toronto, Department of Psychiatry, Ontario, Canada. * 5 University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. * 6 University of Florida, Department of Epidemiology, GainesvilleFlorida, United States of America. * 7 University of California San Francisco, San Francisco, California, United States of America. * 8 Georgetown Medical Center, Department of Medicine, Washington, District of Columbia, United States of America. * 9 Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America. * 10 University of California San Diego School of Medicine, San Diego, California, United States of America. * 11 University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, North Carolina, United States of America. * 12 University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, Pennsylvania, United States of America. * 13 The State University of New York, Department of Psychology, Buffalo, New York, United States of America. * PMID: **42611874** * DOI: [ 10.1371/journal.pone.0356296 ](https://doi.org/10.1371/journal.pone.0356296) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The prevalence of cigarette use in people with HIV (PWH) is 2-3 times higher than the general population. Cigarette use increases risk of myocardial infarction (MI). Faster nicotine metabolism, quantified by the nicotine metabolite ratio (NMR) is associated with greater risk for nicotine dependence and lung cancer, but its association with MI is unknown. **Methods:** We conducted a nested case-control study within the Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Cases were PWH who reported cigarette use with incident adjudicated MI between 2003 and 2020 and available plasma samples; cigarette-smoking controls were selected by incidence density sampling, matched on age, race, birth sex, and plasma HIV RNA level. Conditional logistic regression was used to estimate odds ratios (OR) for the association of NMR and MI. **Results:** We identified 135 cases wit
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