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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.
- Source :
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BMJ (Clinical research ed.) [BMJ] 2015 Apr 20; Vol. 350, pp. h1551. Date of Electronic Publication: 2015 Apr 20. - Publication Year :
- 2015
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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.<br />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.<br />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.<br />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.<br /> (© Mons et al 2015.)
- Subjects :
- Age Factors
Aged
Cardiovascular Diseases prevention & control
Europe epidemiology
Female
Health Knowledge, Attitudes, Practice
Humans
Incidence
Male
Middle Aged
North America epidemiology
Proportional Hazards Models
Prospective Studies
Risk Factors
Smoking Prevention
Stroke prevention & control
Cardiovascular Diseases mortality
Smoking mortality
Smoking Cessation
Stroke mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1756-1833
- Volume :
- 350
- Database :
- MEDLINE
- Journal :
- BMJ (Clinical research ed.)
- Publication Type :
- Academic Journal
- Accession number :
- 25896935
- Full Text :
- https://doi.org/10.1136/bmj.h1551