Association of Smoking Cessation With Subsequent Risk of Cardiovascular Disease

Abstract

The time course of cardiovascular disease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years. OBJECTIVE To evaluate the association between years since quitting smoking and incident CVD. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015. EXPOSURES Time-updated self-reported smoking status, years since quitting, and cumulative pack-years. MAIN OUTCOMES AND MEASURES Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (Ն20 pack-years). RESULTS The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n = 4965) with a mean age of 42.2 (SD, 11.8) years and 45% male. There were 5308 ever smokers with a median 17.2 (interquartile range, 7-30) baseline pack-years, including 2371 heavy ever smokers (406 [17%] former and 1965 [83%] current). Over 26.4 median follow-up years, 2435 first CVD events occurred (original cohort: n = 1612 [n = 665 among heavy smokers]; offspring cohort: n = 823 [n = 430 among heavy smokers]). In the pooled cohort, compared with current smoking, quitting within 5 years was associated with significantly lower rates of incident CVD (incidence rates per 1000 person-years: current smoking, 11.56 [95% CI, 10.30-12.98]; quitting within 5 years, 6.94 [95% CI, 5.61-8.59]; difference, −4.51 [95% CI, −5.90 to −2.77]) and lower risk of incident CVD (hazard ratio, 0.61; 95% CI, 0.49-0.76). Compared with never smoking, quitting smoking ceased to be significantly associated with greater CVD risk between 10 and 15 years after cessation in the pooled cohort (incidence rates per 1000 person-years: never smoking, 5.09 [95% CI, 4.52-5.74]; quitting within 10 to <15 years, 6.31 [95% CI, 4.93-8.09]; difference, 1.27 [95% CI, −0.10 to 3.05]; hazard ratio, 1.25 [95% CI, 0.98-1.60]). CONCLUSIONS AND RELEVANCE Among heavy smokers, smoking cessation was associated with significantly lower risk of CVD within 5 years relative to current smokers. However, relative to never smokers, former smokers' CVD risk remained significantly elevated beyond 5 years after smoking cessation.

Smoking cessation after hospitalization for myocardial infarction or cardiac surgery: Assessing patient interest, confidence, and physician prescribing practices

“…Unfortunately, despite patients' interest in quitting and the fact that SC is the single most effective lifestyle change a patient can make after myocardial infarction, up to 60% of patients who smoke will eventually relapse within 1 year of hospitalization, most of whom will do so within the first 3 weeks following discharge . These two facts only reinforce the notion that starting treatment during hospitalization is critical.…”

“…Questions 5, 6, and 8 used Likert Scales to assess patient interest in quitting smoking, confidence in their ability to quit, and how strongly they feel their smoking habit was related to their hospitalization, respectively. Likert scale questions were averaged, but were also reported grouped in low (1,2), moderate (3), or high (4, 5) categories. Question 9 provided a list of SC methods (ie, medications, exercise, group support, etc.)…”

“…Smoking cessation (SC) provides substantial benefit to patients who are current smokers at the time of their admission in preventing subsequent events . However, patients hospitalized for a cardiac event are often advised to make multiple behavior modifications to achieve a healthier lifestyle.…”

“…However, patients hospitalized for a cardiac event are often advised to make multiple behavior modifications to achieve a healthier lifestyle. Research from more than 10 years ago suggest that smokers are interested in cessation; unfortunately, long‐term SC success rates are disappointingly low as more than 60% of smokers hospitalized for an acute cardiac condition continue smoking post‐discharge . One reason for this may be that smokers feel overwhelmed by the number of behavior changes they are recommended to make and place smoking as a secondary priority compared to other changes such as losing weight or attending cardiac rehabilitation.…”

“…subsequent events. 1 However, patients hospitalized for a cardiac event are often advised to make multiple behavior modifications to achieve a healthier lifestyle. Research from more than 10 years ago suggest that smokers are interested in cessation; unfortunately, longterm SC success rates are disappointingly low as more than 60% of smokers hospitalized for an acute cardiac condition continue smoking post-discharge.…”