title: 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.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany u.mons@dkfz.de.
authors.forename: Ute
authors.initials: U
authors.lastname: Mons
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany.
authors.forename: Aysel
authors.initials: A
authors.lastname: Müezzinler
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Gellert
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Ben
authors.initials: B
authors.lastname: Schöttker
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Lisette
authors.initials: L
authors.lastname: de Groot
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Freedman
authors.affiliation: Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
authors.forename: Eugène
authors.initials: E
authors.lastname: Jansen
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuulasmaa
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Hospital District of North Karelia, Joensuu, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
authors.affiliation: UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: Mark G
authors.initials: MG
authors.lastname: O'Doherty
authors.affiliation: Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Bas
authors.initials: B
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Hellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Philippos
authors.initials: P
authors.lastname: Orfanos
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany German Center for Cardiovascular Disease Research (DZHK eV), partner-site Munich, Munich, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Peters
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Alicja
authors.initials: A
authors.lastname: Wolk
authors.affiliation: Hellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D020521:Stroke / Q000401:mortality* / Q000517:prevention & control