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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
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
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
Author
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
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
Wennberg, Patrik
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
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.
Keywords
Date
2015
Type
Journal article
Journal
BMJ
Book
Volume
350
Issue
12
Page Range
1-12
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access
License
File Access
Open
Notes
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/