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BMJ. 2015 Apr 20;350:h1551. doi: 10.1136/bmj.h1551.

Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium.

Author information

1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany u.mons@dkfz.de.
2
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany.
3
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
4
National Cancer Institute, Bethesda, MD, USA.
5
Department of Epidemiology and Public Health, University College London, London, UK.
6
Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
7
Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
8
UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
9
National Institute for Health and Welfare (THL), Helsinki, Finland.
10
National Institute for Health and Welfare (THL), Helsinki, Finland Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Hospital District of North Karelia, Joensuu, Finland.
11
Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
12
Hellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
13
Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany German Center for Cardiovascular Disease Research (DZHK eV), partner-site Munich, Munich, Germany.
14
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
15
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
16
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
17
Hellenic Health Foundation, Athens, Greece Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Abstract

OBJECTIVE:

To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures.

DESIGN:

Individual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis.

RESULTS:

Overall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar.

CONCLUSIONS:

Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.

PMID:
25896935
PMCID:
PMC4413837
DOI:
10.1136/bmj.h1551
[Indexed for MEDLINE]
Free PMC Article

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