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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

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  • Ute Mons
  • Aysel Müezzinler
  • Carolin Gellert
  • Ben Schöttker
  • Christian C Abnet
  • Martin Bobak
  • Lisette CPGM de Groot
  • Neal D Freedman
  • Eugène Jansen
  • Frank Kee
  • Daan Kromhout
  • Kari Kuulasmaa
  • Laatikainen Tiina
  • Mark G O'Doherty
  • Bueno De Mesquita Bas
  • Philippos Orfanos
  • Annette Peters
  • Yvonne T van der Schouw
  • Tom Wilsgaard
  • Alicja Wolk
  • Antonia Trichopoulou
  • Paolo Boffetta
  • Hermann Brenner
  • Migle Baceviciene
  • Jolanda M A Boer
  • Wojciech Drygas
  • Sture Eriksson
  • Edith Jm Feskens
  • Valeriy Gafarov
  • Julian Gardiner
  • Niclas Håkansson
  • Jan-Håkan Jansson
  • Pekka Jousilahti
  • Ellen Kampman
  • Jukka Kontto
  • Ruzena Kubinova
  • Max Leenders
  • Allan Linneberg
  • Maja-Lisa Løchen
  • Roberto Lorbeer
  • Sofia Malyutina
  • Ellisiv B. Mathiesen
  • Håkan Melhus
  • Karl Michaëlsson
  • Inger Njølstad
  • Nicola Orsini
  • Andrzej Pająk
  • Hynek Pikhart
  • Charlotta Pisinger
  • Galatios Siganos
  • CHANCES consortium
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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.

Original languageEnglish
Article numberh1551
JournalBritish Medical Journal
Volume350
ISSN0959-8146
DOIs
Publication statusPublished - 20 Apr 2015

ID: 51771272