title: Impact of smoking and quitting on cardiovascular outcomes and risk advancement periods among older adults.
abstract: Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. However, most pertinent studies primarily relied on middle aged adults. We aimed to provide empirical evidence on the association of smoking with cardiovascular events and the benefits of smoking cessation in people aged 50 years or older. In a German population-based cohort study detailed information on lifetime smoking history was obtained from 8,807 individuals aged 50-74 years, without previous myocardial infarction (MI) or stroke. Cox proportional hazards regression was applied to estimate the impact of smoking on MI, stroke and cardiovascular death (CVD) as well as on the combined outcome of major cardiovascular events (MI, stroke or CVD). In addition, the impact of smoking and the benefits of smoking cessation were quantified by risk advancement periods (RAP). The cohort included 17.2 % current smokers, 31.7 % former smokers and 51.1 % never smokers. During a mean follow-up of 9.1 years, 261 participants experienced a first MI, 456 had a primary stroke and 274 died of cardiovascular reasons. Compared to never smokers, adjusted hazard ratios (95 % confidence intervals) of current smokers were 2.25 (1.62-3.12), 2.12 (1.65-2.73) and 2.45 (1.76-3.42) and RAPs were 19.3, 9.8 and 8.4 years for MI, stroke and CVD, respectively. Strong dose-response relationships were seen with both current and life-time amount of smoking. Most of the excess risk and risk advancement disappeared within 5 years after smoking cessation. Smoking is a strong risk factor for cardiovascular events even at older age. Smoking cessation is highly and rapidly beneficial also at advanced age.
authors: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
authors: Carolin
authors: C
authors: Gellert
authors: Ben
authors: B
authors: Schöttker
authors: Heiko
authors: H
authors: Müller
authors: Bernd
authors: B
authors: Holleczek
authors: Hermann
authors: H
authors: Brenner
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D020521:Stroke / Q000453:epidemiology
references: Stroke. 2009 Jul;40(7):2319-26
references: 19520994
references: Epidemiology. 1995 May;6(3):227-31
references: 7619927
references: J Am Geriatr Soc. 2010 Oct;58 Suppl 2:S325-8
references: 21029062
references: Tob Control. 2010 Jun;19(3):248-54
references: 20501499
references: Curr Med Chem Cardiovasc Hematol Agents. 2005 Jan;3(1):45-54
references: 15638743
references: Am Heart J. 2010 Jul;160(1):102-8
references: 20598979
references: Climacteric. 2012 Apr;15 Suppl 1:11-7
references: 22432811
references: Dtsch Med Wochenschr. 2004 Dec 3;129(49):2643-7
references: 15578318
references: Exp Clin Psychopharmacol. 2011 Jun;19(3):192-202
references: 21480728
references: Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):174-9
references: 19247184
references: Eur J Epidemiol. 2004;19(5):417-24
references: 15233313
references: Ann Intern Med. 2012 Jul 17;157(2):104-13
references: 22786830
references: Menopause. 2012 Aug;19(8):931-41
references: 22453198
references: J Epidemiol Community Health. 2004 Nov;58(11):917-23
references: 15483307
references: Ann Epidemiol. 2004 Jul;14(6):416-24
references: 15246330
references: Circ J. 2011;75(12):2885-92
references: 21979146
references: Heart. 2009 Aug;95(15):1250-7
references: 19389720
references: BMC Public Health. 2011 May 04;11:273
references: 21542909
references: Am J Epidemiol. 2004 Jul 15;160(2):173-7
references: 15234939
references: Stroke. 2011 Apr;42(4):952-9
references: 21311063
references: Lancet. 2011 Oct 8;378(9799):1297-305
references: 21839503
references: Eur J Cardiovasc Prev Rehabil. 2008 Dec;15(6):663-9
references: 18779737
references: Expert Rev Cardiovasc Ther. 2010 Jul;8(7):917-32
references: 20602553
references: Epidemiology. 1994 Mar;5(2):189-96
references: 8172994
references: Lancet. 2006 Aug 19;368(9536):647-58
references: 16920470
references: Int J Epidemiol. 2005 Oct;34(5):1036-45
references: 15914503
references: Eur Heart J. 1998 Aug;19(8):1197-207
references: 9740341
references: Drug Alcohol Depend. 2010 Apr 1;108(1-2):122-9
references: 20061096
references: Epidemiology. 1993 May;4(3):229-36
references: 8512987
references: BMJ. 2012 Oct 09;345:e6409
references: 23048011
references: Am J Epidemiol. 2012 Apr 15;175(8):816-26
references: 22396389
references: Am J Epidemiol. 2000 Nov 1;152(9):884-8
references: 11085401
references: Lancet. 2006 May 27;367(9524):1747-57
references: 16731270
references: Arch Intern Med. 2012 Jun 11;172(11):837-44
references: 22688992
references: Stroke. 2008 Jun;39(6):1688-93
references: 18323480
references: J Clin Epidemiol. 1994 Jul;47(7):731-7
references: 7722586
references: Can J Clin Pharmacol. 2008 Winter;15(1):e22-35
references: 18579928