Περίληψη:
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.
DESIGN
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.
Συγγραφείς:
Mons, Ute
Mueezzinler, Aysel
Gellert, Carolin
Schoettker,
Ben
Abnet, Christian C.
Bobak, Martin
de Groot, Lisette and
Freedman, Neal D.
Jansen, Eugene
Kee, Frank
Kromhout, Daan
and Kuulasmaa, Kari
Laatikainen, Tiina
O'Doherty, Mark G. and
Bueno-de-Mesquita, Bas
Orfanos, Philippos
Peters, Annette and
van der Schouw, Yvonne T.
Wilsgaard, Tom
Wolk, Alicja and
Trichopoulou, Antonia
Boffetta, Paolo
Brenner, Hermann and
CHANCES Consortium
