Journal
BMJ-BRITISH MEDICAL JOURNAL
Volume 350, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmj.h1551
Keywords
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Categories
Funding
- European Commission [HEALTH-F3-2010-242244, QLK6-CT-2001-00360, RII-CT-2006-062193, CIT5-CT-2005-028857, CIT4-CT-2006-028812, 211909, 227822, 261982]
- National Institute of Aging in the United States
- ELSA
- Hellenic Health Foundation
- European Commission (DG SANCO)
- Dutch Ministry of Public Health, Welfare and Sports (VWS)
- National Institute for Public Health and the Environment
- Dutch Cancer Society, the Netherlands Organisation for Health Research and Development (ZONMW)
- World Cancer Research Fund (WCRF)
- Health Research Fund (FIS) of the Spanish Ministry of Health RTICC 'Red Tematica de Investigacion Cooperativa en Cancer [Rd06/0020/0091, Rd12/0036/0018]
- Regional Governments of Andalucia, Asturias, Basque Country, Murcia [6236]
- Navarra, Instituto de Salud Carlos III, Redes de Investigacion Cooperativa [RD06/0020]
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane
- Baden-Wurttemberg state Ministry of Science, Research and Arts (Stuttgart, Germany)
- Federal Ministry of Education and Research (Berlin, Germany)
- Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (Berlin, Germany)
- Wellcome Trust [064947, 081081]
- US National Institute on Aging [R01 AG23522-01, U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11, OGHA 04-064]
- Mac Arthur Foundation
- European Union [HEALTH-F4-2007-201413, 278913]
- Intramural Research Program of the National Cancer Institute (NCI), NIH
- German Ministry of Education and Research
- Swedish Research Council
- Karolinska Institutet
- UiT The Arctic University of Norway
- National Screening Service
- Research Council of Norway
- Netherlands Prevention Foundation
- Klaus Tschira Foundation
- MRC [G0601463] Funding Source: UKRI
- Medical Research Council [MC_CF023241, G0601463] Funding Source: researchfish
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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.
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