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
Year: 2015
Type: review
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.
Source: BMJ
DOI: 10.1136/bmj.h1551
Authors: U. Mons, A. Muezzinler, C. Gellert, B. Schottker, C. C. Abnet, M. Bobak, L. de Groot, N. D. Freedman, E. Jansen, F. Kee, D. Kromhout, K. Kuulasmaa, T. Laatikainen, M. G. O'Doherty, B. Bueno-de-Mesquita, P. Orfanos, A. Peters, Y. T. van der Schouw, T. Wilsgaard, A. Wolk, A. Trichopoulou, P. Boffetta, H. Brenner
Institutions: German Cancer Research Center, Heidelberg University, National Institutes of Health, National Cancer Institute, University College London, Wageningen University & Research, National Institute for Public Health and the Environment, Queen's University Belfast, Finnish Institute for Health and Welfare, University of Eastern Finland, North Karelia Central Hospital, University Medical Center Utrecht, University of Malaya, Imperial College London, National and Kapodistrian University of Athens, Hellenic Health Foundation, Helmholtz Munich, German Centre for Cardiovascular Research, UiT The Arctic University of Norway, Karolinska Institutet, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,415
Funders: Universitetet i Tromsø, Wellcome Trust, Government of the United Kingdom, University College London, European Commission, ZonMw, Bundesministerium für Bildung und Forschung, Cancerfonden, Karolinska Institutet, Vetenskapsrådet, KWF Kankerbestrijding, Norges Forskningsråd, Klaus Tschira Stiftung, Hellenic Health Foundation, National Institutes of Health, Centers for Disease Control and Prevention, World Cancer Research Fund, Instituto de Salud Carlos III, National Institute on Aging, National Cancer Institute
Awards: Multinational Advancement of Research Infrastructures on Ageing, G1330667123, G1428006373, G1501080556, G1750703574, G1778268290, G1820526844, Determinants of cardiovascular diseases in Eastern Europe: a multi-centre cohort study., G1952936224, G2077389594, G2343781458, Biomarker for Cardiovascular Risk Assessment in Europe, G24207250, G2465118858, G2540498256, G2881429984, G288447808, G3166864496, G3170664214, G323020161, G3457581384, G3461390129, G3687180791, G3970580488, G3998443608, HEALTH AND ECONOMIC STATUS IN OLDER POPULATIONS, RAND Center for the Study of Aging, Upgrading the Survey of Health, Ageing and Retirement in Europe – preparatory phase, G441882524, G45297283, Health disparities and aging in societies in transition, G4569152855, European Network for Genetic and Genomic Epidemiology, G4847675667, G4885864782, G5091277398, G5456958854, G5618942462, G5932924763, G7233991284, G7328727475, DEVELOPING AN ISRAELI VERSION OF THE HRS/SHARE PROJECT, Consortium on Health and Ageing: Network of Cohorts in Europe and the United States, G8012318887, G8243934955, Determinants of cardiovascular diseases in Eastern Europe: Longitudinal follow up of a multi-centre cohort study (The HAPIEE Project)., Longitudinal Enhancement and Access imProvement of the SHARE infrastructure, G8721838990, G873424642, G876765158, G8799806375, Understanding and Improving Healthcare Decision-Making and Outcomes for People Living with Alzheimer's Disease and Related Dementias, Health and Retirement Study: Yrs 35-40, G93458789, G938892667, G939349750
OpenAlex ID: W2132279603