title: The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV(1)--a review.
abstract: Searches identified 14 studies investigating effects of reducing cigarette consumption on lung cancer, CVD, COPD or FEV1 decline. Three were case-control studies, six cohort studies, and five follow-up studies of FEV1. Six studies consistently reported lower lung cancer risk in reducers. Compared to non-reducers, meta-analysis (random-effects) showed significantly lower risk (RR 0.81, 95% CI 0.74-0.88 for any reduction, and RR 0.78, 0.66-0.92 for the greatest reduction), with no between-study heterogeneity. Four cohort studies presented CVD results, the combined RR for any reduction being a non-significant 0.93 (0.84-1.03). An effect of reduction was not consistently seen for COPD or FEV1 decline. Four cohort studies presented all-cause mortality results, the combined RR of 0.92 (0.85-1.01) being non-significant. The RR of 0.95 (0.88-1.02) for total smoking-related cancer, from three studies, was also non-significant. The evidence has various weaknesses; few studies, few cases in reducers in some studies, limited dose-response data, incomplete adjustment for baseline consumption, questionable accuracy of the lifetime smoking history data in case-control studies, and bias in cohort studies if reducers are likelier than non-reducers to quit during follow-up. Also, the variable definitions of reduction make meta-analysis problematic. Though the results suggest some benefits of smoking reduction, more evidence is needed.
authors.affiliation: P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK. Electronic address: PeterLee@pnlee.co.uk.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Lee
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality / Q000503:physiopathology; D000074606:Smoking Prevention
keywords: AMI; BMI; CHD; CI; COPD; CVD; Cancer; Circulatory disease; FEV(1); ICD; IHD; OR; RD; RR; Respiratory disease; SES; STR; TC; TRC; Tobacco; acute myocardial infarction; body mass index; cardiovascular disease; chronic obstructive pulmonary disease; confidence interval; coronary heart disease; forced expiratory volume in one second; international classification of diseases; ischaemic heart disease; odds ratio; relative risk; respiratory disease; socio-economic status; stroke; tobacco related cancer; total cancer