Age at quitting smoking as a predictor of risk of cardiovascular disease incidence independent of smoking status, time since quitting and pack-years (original) (raw)

Framingham Risk Prediction Equations for Incidence of Cardiovascular Disease Using Detailed Measures for Smoking

Heart, Lung and Circulation, 2010

Current prediction models for risk of cardiovascular disease (CVD) incidence incorporate smoking as a dichotomous yes/no measure. However, the risk of CVD associated with smoking also varies with the intensity and duration of smoking and there is a strong association between time since quitting and the risk of disease onset. This study aims to develop improved risk prediction equations for CVD incidence incorporating intensity and duration of smoking and time since quitting. The risk of developing a first CVD event was evaluated using a Cox's model for participants in the Framingham offspring cohort who attended the fourth examination (1988-92) between the ages of 30 and 74 years and were free of CVD (n=3751). The full models based on the smoking variables and other risk factors, and reduced models based on the smoking variables and non-laboratory risk factors demonstrated good discrimination, calibration and global fit. The incorporation of both time since quitting among past smokers and packyears among current smokers resulted in better predictive performance as compared to a dichotomous current/non-smoker measure and a current/quitter/never smoker measure. Compared to never smokers, the risk of CVD incidence increased with pack-years. Risk among those quitting more than five years prior to the baseline exam and within five years prior to the baseline exam were similar and twice as high as that of never smokers. A CVD risk equation incorporating the effects of pack-years and time since quitting provides an improved tool to quantify risk and guide preventive care.

Smoking cessation and the risk of cardiovascular disease outcomes predicted from established risk scores: Results of the Cardiovascular Risk Assessment among Smokers in Primary Care in Europe (CV-ASPIRE) Study

BMC Public Health, 2013

Background: Smoking is a major risk factor for cardiovascular disease (CVD). This multicenter, cross-sectional survey was designed to estimate the cardiovascular (CV) risk attributable to smoking using risk assessment tools, to better understand patient behaviors and characteristics related to smoking, and characterize physician practice patterns. Methods: 1,439 smokers were recruited from Europe during 2011. Smokers were ≥40 years old, smoked > 10 cigarettes/day and had recent measurements on blood pressure and lipids. CV risk was calculated using the SCORE system, Framingham risk equations, and Progetto CUORE model. The CV risk attributable to smoking was evaluated using a simulated control (hypothetical non-smoker) with identical characteristics as the enrolled smoker. Risks assessed included CV mortality, coronary heart disease (CHD), CVD and hard CHD. Demographics, comorbidities, primary reasons for consultation, behavior towards previous attempts to quit, and interest in smoking cessation was assessed. Dependence on nicotine was evaluated using the Fagerström Test for Nicotine Dependence. GP practice patterns were assessed through a questionnaire. Results: The prediction models consistently demonstrated a high CV risk attributable to smoking. For instance, the SCORE model demonstrated that this study population of smokers have a 100% increased probability of death due to cardiovascular disease in the next 10-years compared to non-smokers. A considerable amount of patients would like to hear from their GP about the different alternatives available to support their quitting attempt. Conclusions: The findings of this study reinforce the importance of smoking as a significant predictor of long-term cardiovascular events. One of the best gains in health could be obtained by tackling the most important modifiable risk factors; these results suggest smoking is among the most important.

Association of Smoking Cessation and Survival Among Young Adults With Myocardial Infarction in the Partners YOUNG-MI Registry

JAMA Network Open, 2020

IMPORTANCE Despite significant progress in primary prevention, the rate of myocardial infarction (MI) continues to increase in young adults. OBJECTIVES To identify the prevalence of tobacco use and to examine the association of both smoking and smoking cessation with survival in a cohort of adults who experienced an initial MI at a young age. DESIGN, SETTING, AND PARTICIPANTS The Partners YOUNG-MI registry is a retrospective cohort study from 2 large academic centers in Boston, Massachusetts, that includes patients who experienced an initial MI at 50 years or younger. Smoking status at the time of presentation and at 1 year after MI was determined from electronic medical records. Participants were 2072 individuals who experienced an MI at 50 years or younger between January 2000 and April 2016. The dates of analysis were October to December 2019. MAIN OUTCOMES AND MEASURES Deaths were ascertained from the Social Security Administration Death Master File, the Massachusetts Department of Vital Statistics, and the National Death Index. Cause of death was adjudicated independently by 2 cardiologists. Propensity scoreadjusted Cox proportional hazards modeling was used to evaluate the association between smoking cessation and both all-cause and cardiovascular mortality. RESULTS Among the 2072 individuals (median age, 45 years [interquartile range, 42-48 years]; 1669 [80.6%] men), 1088 (52.5%) were smokers at the time of their index hospitalization. Of these, 910 patients were further classified into either the cessation group (343 [37.7%]) or the persistent smoking group (567 [62.3%]) at 1 year after MI. Over a median follow-up of 11.2 years (interquartile range, 7.3-14.2 years), individuals who quit smoking had a statistically significantly lower rate of all-cause mortality (hazard ratio [HR], 0.35; 95% CI, 0.19-0.63; P < .001) and cardiovascular mortality (HR, 0.29; 95% CI, 0.11-0.79; P = .02). These values remained statistically significant after propensity score adjustment (HR, 0.30 [95% CI, 0.16-0.56; P < .001] for all-cause mortality and 0.19 [95% CI, 0.06-0.56; P = .003] for cardiovascular mortality). CONCLUSIONS AND RELEVANCE In this cohort study, approximately half of individuals who experienced an MI at 50 years or younger were active smokers. Among them, smoking cessation within 1 year after MI was associated with more than 50% lower all-cause and cardiovascular mortality.

Cardiovascular risk of smoking and benefits of smoking cessation

Journal of Thoracic Disease

Introduction: the causal link Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality throughout the world. In the United States, CVDs affect many racial or ethnic groups, and this fact has an extremely high cost that is estimated around $200 billion annually in healthcare services, drugs, and loss of productivity. Much of this burden is due to insufficient implementation of prevention strategies and poor control of atherosclerotic cardiovascular disease (ASCVD) risk factors in many adults (1,2). According to World Health Organization data, smoking determines 10% of all CVDs (3). Tobacco smoking usage causes approximately 6 million death per year throughout the world, in the United States almost 500,000 deaths can be attributed to smoking and about 10% of these deaths are caused from secondhand smoke exposure. Epidemiologic studies have supported the assumption that cigarette smoking increases the incidence of myocardial infarction and fatal coronary artery diseases (4). The increased risk of cardiovascular events has also been shown for low-tar cigarettes and smokeless tobacco. Even passive smoking is responsible for a 30% increased risk of ASCVD, a little less than half of the risk increase in active smokers that is around 80% (5,6). Ever since the Framingham study, the epidemiologic investigations have tried to identify people with a high likelihood for a future cardiovascular events in order to make actionable interventions to reduce the risk. The concept of "risk factors" was made popular by Kannel et Review Article on Improving Outcomes in Lung Cancer Through Early Diagnosis and Smoking Cessation

Importance of total life consumption of cigarettes as a risk factor for coronary artery disease

The American Journal of Cardiology, 1985

Cigarette smoking is an established risk factor for the occurrence of cardiovascular events and mortality. Whether recent smoking history or total life consumption best represents the increased risk due to smoking has not been previously established. Thus, stepwise logistic regression analysis was used to determine the relative contributions of these factors to the risk of having significant coronary artery disease in 1,349 patients who underwent cardiac catheterization. Six risk factors were analyzed: total pack-years, current packs smoked per day, age, gender, family history and symptomatic status. The results of this analysis showed that total pack-years, but not current packs per day, is a significant independent risk factor for the development of coronary artery disease. This was true in every age group up to but not older than age 70 years. Although the overall risk was lower in younger patients and in patients with less typical symptoms of angina, the relative risk in cigarette smokers relative to pack-years was consistently greater. The risk of total life consumption of cigarettes is thus greater than has heretofore been realized, particularly in persons who would otherwise be categorized as low risk.

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1 937 360 people in England: lifetime risks and implications for risk prediction

International journal of epidemiology, 2015

It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation. Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme). During 11.6 million person-years of follow-up, 114 859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers' lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ra...