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. 2024 Nov 4;7(11):e2442639.
doi: 10.1001/jamanetworkopen.2024.42639.

Smoking Cessation and Incident Cardiovascular Disease

Jun Hwan Cho  1   2 , Seung Yong Shin  3 , Hoseob Kim  4 , Mina Kim  4 , Kyeongmin Byeon  1   2 , Moonki Jung  1   2 , Ki-Woon Kang  5   6 , Wang-Soo Lee  5   6 , Sang-Wook Kim  1   2 , Gregory Y H Lip  7   8
Affiliations

Smoking Cessation and Incident Cardiovascular Disease

Jun Hwan Cho et al. JAMA Netw Open. .

Abstract

Importance: The association between smoking cessation and cardiovascular disease (CVD) risk in relation to cumulative smoking exposure remains poorly understood.

Objective: To evaluate the associations among smoking cessation, lifetime smoking burden, and CVD risk according to the number of years elapsed after smoking cessation.

Design, setting, and participants: This retrospective cohort study of the Korean National Health Insurance Service database investigated smoking duration and intensity between January 2006 and December 2008. Participants were categorized by self-reported smoking habits as current, ex-, or never-smokers. Smoking records were updated every 2 years until December 2019, with participants whose smoking status changed or whose smoking status was unclear excluded. Data analysis was performed between June and December 2022.

Exposures: Time-updated self-reported smoking status, years since quitting, and cumulative smoking amount (pack-years [PY]).

Main outcomes and measures: The primary outcome was incidence and hazard ratio of CVD (composite of cardiovascular death, myocardial infarction, stroke, and heart failure).

Results: Overall, 5 391 231 participants (39.9% male; mean [SD] age, 45.8 [14.7] years; 853 756 [15.8%] current smokers, 104 604 [1.9%] ex-smokers, and 4 432 871 [82.2%] never smokers) were followed up for a mean (SD) of 4.2 (4.4) years. The median (IQR) baseline cumulative smoking amounts were 14.0 (7.5-20.0) PY in current smokers and 10.5 (5.3-20.0) PY in ex-smokers. The median (IQR) duration of smoking cessation was 4 (2-8) years for ex-smokers. Regardless of continued smoking, a dose-dependent association was evident between smoking and incident CVD. Compared with current smokers, ex-smokers with a lifetime smoking burden of less than 8 PY (light ex-smokers) experienced a significant reduction in CVD risk within 10 years of cessation, with a CVD risk similar to that of never-smokers. Conversely, ex-smokers with at least 8 PY (heavy ex-smokers) exhibited a slower decline in CVD risk than light ex-smokers, requiring more than 25 years for the residual CVD risk to disappear.

Conclusions and relevance: In this cohort study, smoking and CVD risk exhibited a dose-dependent association, with light ex-smokers having a CVD risk similar to that of never-smokers relatively soon after smoking cessation. For heavy ex-smokers, greater than 25 years might be required for the residual CVD risk to align with that of never-smokers.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lip reported being a consultant and speaker for Bristol Myers Squibb/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthos (no fees were received personally) outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
Figure 2.
Figure 2.. Risk of Incident Cardiovascular Disease in Ever and Never Smokers
Heavy ex-smokers were ex-smokers with a lifetime smoking burden of ≥8 pack-years (PY); light ex-smokers were ex-smokers with a lifetime smoking burden of <8 PY. An adjusted HR greater than 1 indicates higher risk in the ex-smoker group. CVD indicates cardiovascular disease; HR, hazard ratio.
See this image and copyright information in PMC

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