Relative risk for cardiovascular atherosclerotic events after smoking cessation: 6-9 years excess risk in individuals with familial hypercholesterolemia.
BACKGROUND
Smoking history is often di- or trichotomized into for example "never, ever or current smoking". However, smoking must be treated as a time-dependent covariate when lifetime data is available. In particular, individuals do not smoke at birth, there is usually a wide variation with respect to smoking history, and smoking cessation must also be considered.


METHODS
Therefore we analyzed smoking as a time-dependent risk factor for cardiovascular atherosclerotic events in a cohort of 2400 individuals with familial hypercholesterolemia who were followed from birth until 2004. Excess risk after smoking-cessation was modelled in a Cox regression model with linear and exponential decaying trends. The model with the highest likelihood value was used to estimate the decay of the excess risk of smoking.


RESULTS
Atherosclerotic events were observed in 779 patients with familial hypercholesterolemia and 1569 individuals had a smoking history. In the model with the highest likelihood value the risk reduction of smoking after cessation follows a linear pattern with time and it appears to take 6 to 9 years before the excess risk is reduced to zero. The risk of atherosclerotic events due to smoking was estimated as 2.1 (95% confidence interval 1.5; 2.9).


CONCLUSIONS
It was concluded that excess risk due to smoking declined linearly after cessation in at least six to nine years.
Kramer
Anneke
A
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands. a.kramer@amc.uva.nl <a.kramer@amc.uva.nl>
Jansen
Angelique C M
AC
van Aalst-Cohen
Emily S
ES
Tanck
Michael W T
MW
Kastelein
John J P
JJ
Zwinderman
Aeilko H
AH
D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D005192:Family Health; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications* / Q000235:genetics; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors