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. 2024 Sep 7:16:605-616.
doi: 10.2147/CLEP.S440815. eCollection 2024.

Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035

Johann Kuhn  1 , Valérie Olié  2 , Clémence Grave  2 , Yann Le Strat  1 , Christophe Bonaldi  1 , Pierre Joly  1   3
Affiliations

Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035

Johann Kuhn et al. Clin Epidemiol. .

Abstract

Aim: Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035.

Methods and results: The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females.

Conclusion: While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.

Keywords: burden; myocardial infarction; prevalence; projection; smoking prevalence; tobacco control.

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Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Figure 1
Figure 1
Six-state model for smokers. λ01S and λ01FS are the incidence rate of MI, λ02Sand λ02FS the mortality rate of healthy individuals for smokers and new former smokers, respectively, and λ12 the mortality rate of diseased individuals in the general population. The term λ0S→0FS models the smoking cessation rate of smokers.
Figure 2
Figure 2
Estimated MI incidence rate in the general population by age in 2035 for males (left) and females (right) according to the scenarios SC1 (solid line), SC3 (dashed line), and SC4 (dotted line), SC2 is not shown because it overlaps with SC1.
Figure 3
Figure 3
Estimated general population size by age in 2035 for males (left) and for females (right) according to the scenarios SC1 (solid line), SC3 (dashed line), and SC4 (dotted line), SC2 is not shown because it overlaps with SC1.
Figure 4
Figure 4
Estimated MI prevalence by year from 2015 to 2035 for males (left) and females (right) according to the scenarios SC1 (solid line), SC3 (dashed line), and SC4 (dotted line), SC2 is not shown because it overlaps with SC1.
See this image and copyright information in PMC

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