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

Journal article


Mons, Ute, Müezzinler, Aysel, Gellert, Carolin, Schottker, Ben, Abnet, Christian C., Bobak, Martin, de Groot, Lisette C.P.G.M., Freedman, Neal D., Jansen, Eugène, Kee, Frank, Kromhout, Daan, Kuulasmaa, Kari, Laatikainen, Tiina, O'Doherty, Mark G., Bueno-de-Mesquita, Bas, Orfanos, Philippos, Peters, Annette, van der Schouw, Yvonne T., Wilsgaard, Tom, ... Wennberg, Patrik. (2015) 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. BMJ. 350(12), pp. 1 - 12. https://doi.org/10.1136/bmj.h1551
AuthorsMons, Ute, Müezzinler, Aysel, Gellert, Carolin, Schottker, Ben, Abnet, Christian C., Bobak, Martin, de Groot, Lisette C.P.G.M., Freedman, Neal D., Jansen, Eugène, Kee, Frank, Kromhout, Daan, Kuulasmaa, Kari, Laatikainen, Tiina, O'Doherty, Mark G., Bueno-de-Mesquita, Bas, Orfanos, Philippos, Peters, Annette, van der Schouw, Yvonne T., Wilsgaard, Tom, Wolk, Alicja, Trichopoulou, Antonia, Boffetta, Paolo, Brenner, Hermann, Baceviciene, Migle, Boer, Jolanda M. A., Drygas, Wojciech, Eriksson, Sture, Feskens, Edith, Gafarov, Valeriy, Gardiner, Julian, Håkansson, Niclas, Jansson, Jan-Håkan, Jousilahti, Pekka, Kampman, Ellen, Kontto, Jukka, Kubinova, Ruzena, Leenders, Max, Linneberg, Allan, Loechen, Maja-Lisa, Lorbeer, Roberto, Malyutina, Sofia, Mathiesen, Ellisiv Bøgeberg, Melhus, Håkan, Michaëlsson, Karl, Njølstad, Inger, Orsini, Nicola, Pająk, Andrzej, Pikhart, Hynek, Pisinger, Charlotta, Salomaa, Veikko, Sánchez, María-José, Sans, Susana, Schaan, Barbara, Schneider, Andrea, Siganos, Galatios, Söderberg, Stefan, Streppel, Martinette, Tamošiūnas, Abdonas, Veronesi, Giovanni, Waterham, Eveline and Wennberg, Patrik
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 Diseases. 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.

Year2015
JournalBMJ
Journal citation350 (12), pp. 1 - 12
PublisherBMJ Publishing Group
ISSN1756-1833
Digital Object Identifier (DOI)https://doi.org/10.1136/bmj.h1551
Scopus EID2-s2.0-84929497683
Open accessOpen access
Page range1 - 12
Research GroupMary MacKillop Institute for Health Research
Publisher's version
Additional information

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http:// creativecommons.org/licenses/by/4.0/

Place of publicationUnited Kingdom
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