title: Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking.
abstract: BACKGROUND
  According to the 2004 Surgeon General's Report on Health Consequences of Smoking, after >15 years of abstinence, the cardiovascular risk of former smokers becomes similar to that of never-smokers. Whether this health benefit of smoking cessation varies by amount and duration of prior smoking remains unclear.
  
  
  RESULTS
  Of the 4482 adults ≥65 years without prevalent heart failure (HF) in the Cardiovascular Health Study, 2556 were never-smokers, 629 current smokers, and 1297 former smokers with >15 years of cessation, of whom 312 were heavy smokers (highest quartile; ≥32 pack-years). Age-sex-race-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for centrally adjudicated incident HF and mortality during 13 years of follow-up were estimated using Cox regression models. Compared with never-smokers, former smokers as a group had similar risk for incident HF (aHR, 0.99; 95% CI, 0.85-1.16) and all-cause mortality (aHR, 1.08; 95% CI, 0.96-1.20), but former heavy smokers had higher risk for both HF (aHR, 1.45; 95% CI, 1.15-1.83) and mortality (aHR, 1.38; 95% CI, 1.17-1.64). However, when compared with current smokers, former heavy smokers had lower risk of death (aHR, 0.64; 95% CI, 0.53-0.77), but not of HF (aHR, 0.97; 95% CI, 0.74-1.28).
  
  
  CONCLUSIONS
  After >15 years of smoking cessation, the risk of HF and death for most former smokers becomes similar to that of never-smokers. Although this benefit of smoking cessation is not extended to those with ≥32 pack-years of prior smoking, they have lower risk of death relative to current smokers.
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Amiya A
authors.initials: AA
authors.lastname: Ahmed
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Kanan
authors.initials: K
authors.lastname: Patel
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Nyaku
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Raya E
authors.initials: RE
authors.lastname: Kheirbek
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Desai
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.).
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.). aliahmedmdmph@gmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: heart failure; mortality; smoking