title: Expired-air carbon monoxide as a predictor of 16-year risk of all-cause, cardiovascular and cancer mortality.
abstract: BACKGROUND
  Measurement of expired-air carbon monoxide (EACO) is commonly used to ascertain non-smoking status, although it can also reflect exposures not related to smoking. Our aim was to assess 16-year mortality according to EACO measured at baseline, in a general population.
  
  
  METHODS
  Our analysis was based on the Third French MONICA population survey (1994-1997). Causes of death were obtained 16 years after inclusion, and assessment of determinants of mortality was based on Cox modeling.
  
  
  RESULTS
  EACO was measured in 2232 apparently healthy participants aged 35-64. During follow-up, 195 deaths occurred (19% were due to cardio-vascular (CV) causes and 49% to cancer). At baseline, the mean EACO was 11.8 (±7.4)ppm, 4.6 (±2.5)ppm, 4.3 (±2.2)ppm for current, former and never smokers, respectively (P<0.001). After adjustment for main mortality risk factors and smoking, the hazard ratio (HR) for total mortality was 1.03[95% confidence interval: 1.01-1.06] per 1-unit increase in EACO, and it was 1.04[1.01-1.07] for cancer mortality. Adjusted HR for CV mortality was 1.05[1.01-1.10] but did not remain significant after additional adjustment for smoking (0.98[0.91-1.04]). Interactions between EACO and smoking were not significant.
  
  
  CONCLUSIONS
  In a general population, baseline EACO is an independent predictor of 16-year all-cause and cancer mortality, after adjustment for confounders including smoking. Given that the effect of EACO is similar among smokers and non-smokers, EACO is probably not solely related to smoking but could also be a marker of inhaled ambient carbon monoxide and/or endogenous production. Besides, smoking better predicts CV mortality than EACO.
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Toulouse University, Toulouse University Hospital (CHU), Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bérard
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Toulouse University, Toulouse University Hospital (CHU), Toulouse, France.
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.affiliation: Department of Epidemiology and Public Health, INSERM UMR744, Pasteur Institute of Lille, Lille Nord de France University-UDSL, Lille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Department of Epidemiology and Public Health, EA 3430, FMTS, Strasbourg University, Strasbourg, France; Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.affiliation: Department of Epidemiology and Public Health, INSERM UMR744, Pasteur Institute of Lille, Lille Nord de France University-UDSL, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.affiliation: Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Epidemiology and Public Health, INSERM UMR744, Pasteur Institute of Lille, Lille Nord de France University-UDSL, Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Cottel
authors.affiliation: Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Toulouse University, Toulouse University Hospital (CHU), Toulouse, France; Department of Cardiology B, Toulouse University Hospital, Toulouse, France. Electronic address: jean.ferrieres@univ-tlse3.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-Toulouse University, Toulouse University Hospital (CHU), Toulouse, France.
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D002248:Carbon Monoxide
keywords: All-cause mortality; Cancer mortality; Cardiovascular mortality; Expired-air carbon monoxide; General population