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Meta-Analysis
. 2015 Apr 20:350:h1551.
doi: 10.1136/bmj.h1551.

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

Ute Mons  1 , Aysel Müezzinler  2 , Carolin Gellert  3 , Ben Schöttker  3 , Christian C Abnet  4 , Martin Bobak  5 , Lisette de Groot  6 , Neal D Freedman  4 , Eugène Jansen  7 , Frank Kee  8 , Daan Kromhout  6 , Kari Kuulasmaa  9 , Tiina Laatikainen  10 , Mark G O'Doherty  8 , Bas Bueno-de-Mesquita  11 , Philippos Orfanos  12 , Annette Peters  13 , Yvonne T van der Schouw  14 , Tom Wilsgaard  15 , Alicja Wolk  16 , Antonia Trichopoulou  12 , Paolo Boffetta  17 , Hermann Brenner  3 ; CHANCES Consortium
Affiliations
Meta-Analysis

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

Ute Mons et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Meta-analysis of the association of current smoking status with cardiovascular mortality
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Fig 2 Meta-analysis of risk advancement periods (RAP) for current smoking status and cardiovascular mortality
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Fig 3 Cardiovascular mortality summary estimates (random effects model) of hazard ratios and risk advancement periods for categories of cigarette consumption and time since smoking cessation
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Fig 4 Cardiovascular mortality summary estimates (random effects model) of hazard ratios for categories of time since smoking cessation by sex and age
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Fig 5 Acute coronary events and stroke events summary estimates (random effects model) of hazard ratios for current smoking status, cigarette consumption and time since smoking cessation
See this image and copyright information in PMC

Comment in

References

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