File(s) not publicly available

Risk of cardiovascular disease from cumulative cigarette use and the impact of smoking intensity

journal contribution
posted on 01.05.2016, 00:00 authored by J H Lubin, D Couper, P L Lutsey, M Woodward, H Yatsuya, Rachel HuxleyRachel Huxley
© 2016 Wolters Kluwer Health, Inc. All rights reserved. Background: relative risks (rrs) for cardiovascular disease (cVD) by smoking rate exhibit a concave pattern, with rrs in low rate smokers exceeding a linear extrapolation from higher rate smokers. However, cigarettes/day does not by itself fully characterize smoking-related risks. a reexamination of the concave pattern using a comprehensive representation of smoking may enhance insights. Methods: Data were from the atherosclerosis risk in communities (aric) Study, a prospective cohort enrolled in four areas of the US in 1987-1989. Follow-up was through 2008. analyses included 14,233 participants, 245,915 person-years, and 3,411 cVD events. Results: the concave rrs with cigarettes/day were consistent with cigarettes/day modifying a linear rr association of pack-years with cVD (i.e., strength of the pack-years association depended on cigarettes/day, indicating that the manner of pack-years accrual impacted risk). Smoking fewer cigarettes/day for longer duration was more deleterious than smoking more cigarettes/day for shorter duration (P < 0.01). For 50 pack-years (365,000 cigarettes), estimated rrs of cVD were 2.1 for accrual at 20 cigarettes/day and 1.6 for accrual at 50 cigarettes/day. Years since smoking cessation did not alter the diminishing strength of association with increasing cigarettes/day. analyses that accounted for competing risks did not affect findings. Conclusion: Pack-years remained the primary determinant of smoking-related cVD risk; however, accrual influenced rrs. For equal pack-years, smoking fewer cigarettes/day for longer duration was more deleterious than smoking more cigarettes/day for shorter duration. this observation provides clues to better understanding the biological mechanisms, and reinforces the importance of cessation rather than smoking less to reduce cVD risk.

History

Journal

Epidemiology

Volume

27

Issue

3

Pagination

395 - 404

Publisher

Lippincott Williams & Wilkins

Location

Philadelphia, Pa.

ISSN

1044-3983

eISSN

1531-5487

Language

eng

Publication classification

C1 Refereed article in a scholarly journal