The pathophysiology of cigarette smoking and cardiovascular disease

Ambrose, John A.; Barua, Rajat S.

doi:10.1016/j.jacc.2003.12.047

Cited by 1,987 publications

(1,604 citation statements)

References 99 publications

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“…Cigarette smoking is an established risk factor for atherosclerotic cardiovascular disease 1, 32. Consistent with this, smokers presenting with STEMI in our study were ≈8 years younger and were less likely to have vascular risk factors than nonsmokers, providing direct evidence for the deleterious effects of cigarette smoking.…”

Section: Discussionsupporting

confidence: 86%

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Gupta

Kolte

Khera

et al. 2016

JAHA

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BackgroundPrior studies have found that smokers undergoing thrombolytic therapy for ST‐segment elevation myocardial infarction have lower in‐hospital mortality than nonsmokers, a phenomenon called the “smoker's paradox.” Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention.Methods and ResultsWe used the 2003–2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction. Multivariable logistic regression was used to compare in‐hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in‐hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31–0.33, P<0.001). Although the association between smoking and lower in‐hospital mortality was partly attenuated after baseline risk adjustment, a significant residual association remained (adjusted odds ratio 0.60, 95% CI 0.58–0.62, P<0.001). This association largely persisted in age‐stratified analyses. Smoking status was also associated with shorter average length of stay (3.5 versus 4.5 days, P<0.001) and lower incidence of postprocedure hemorrhage (4.2% versus 6.1%; adjusted odds ratio 0.81, 95% CI 0.80–0.83, P<0.001) and in‐hospital cardiac arrest (1.3% versus 2.1%; adjusted OR 0.78, 95% CI 0.76–0.81, P<0.001).ConclusionsIn this nationwide cohort of patients undergoing primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction, we observed significantly lower risk‐adjusted in‐hospital mortality in smokers, suggesting that the smoker's paradox also applies to ST‐segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

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Section: Discussionsupporting

confidence: 86%

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Gupta

Kolte

Khera

et al. 2016

JAHA

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“…Although not significant, this difference between the subgroups may reflect the aforementioned possible effect of smoking as a confounder. Smoking is a well‐known risk factor for atherosclerotic disease, in particular coronary heart disease 44, 51, 52. In our study population, most of the deaths due to cerebrovascular disease were caused by intracranial haemorrhages, and the effect of smoking as a risk factor for this condition is weaker than for coronary heart disease 44, 53, 54, 55.…”

Section: Discussionmentioning

confidence: 71%

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Fossum

Vikanes

Næss

et al. 2016

BJOG

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ObjectiveTo investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long‐term mortality.DesignPopulation‐based cohort study.SettingMedical Birth Registry of Norway (1967–2002) linked to the Cause of Death Registry.PopulationWomen in Norway with singleton births in the period 1967–2002, with and without HG. Women were followed until 2009 or death.MethodsCox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI).Main outcome measuresThe primary outcome was all‐cause mortality during follow up. Secondary outcomes were cause‐specific mortality (cardiovascular mortality, deaths due to cancer, external causes or mental and behavioural disorders).ResultsOf 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person‐years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long‐term all‐cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75–0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84–1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83–1.29), but a lower long‐term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75–0.98).ConclusionIn this large population‐based cohort study, HG was not associated with an increased risk of long‐term all‐cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer.Tweetable abstractPopulation‐based cohort study: Hyperemesis was not associated with an increased risk of long‐term mortality.

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“…At least 14 million cases of serious morbidities are known to attributed by the smoking in the United States,2 including chronic obstructive pulmonary disease, cardiovascular disease,3 stroke,4 and cancer 5. It is also known that 480,000 deaths are attributable to smoking in the United States alone 6.…”

Section: Introductionmentioning

confidence: 99%

Effect of smoking cessation on the risk of dementia: a longitudinal study

Choi

Park

2018

Ann Clin Transl Neurol

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ObjectiveTo determine the risk of developing dementia in relation to duration of smoking cessation by using a nationwide health claims database.MethodsThis cohort study included 46,140 men aged 60 years or older from Korean National Health Insurance System – National Health Screening Cohort, a population‐based national health screening program from 2002 to 2013. The changes in smoking habit from a questionnaire during the first (2002 and 2003) and second (2004 and 2005) health examination periods, participants were divided into continual smokers, short‐term (less than 4 years) quitters, long‐term (4 years or more) quitters, and never smokers. Participants were followed‐up for 8 years from January 1, 2006 for the development of overall dementia, Alzheimer's disease, and vascular dementia.ResultsCompared to continual smokers, long‐term quitters and never smokers had decreased risk of overall dementia (hazard ratio, HR 0.86 95% CI, confidence interval 0.75–0.99 and HR: 0.81; 95% CI: 0.71–0.91, respectively). Never smokers had decreased risk of Alzheimer's disease (HR: 0.82; 95% CI: 0.70–0.96) compared to continual smokers. Finally, both long‐term quitters (HR: 0.68; 95% CI: 0.48–0.96) and never smokers (HR: 0.71; 95% CI: 0.54–0.95) had decreased risk of vascular dementia compared to continual smokers.InterpretationSmoking was associated with increased risk of dementia. Smokers who quit for a prolonged period of time may benefit from reduced risk of dementia. Therefore, smokers should be encouraged to quit in order to reduce the risk of developing dementia, especially in the elderly population who are already at risk.

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The pathophysiology of cigarette smoking and cardiovascular disease

Cited by 1,987 publications

References 99 publications

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Smoker's Paradox in Patients With ST‐Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Effect of smoking cessation on the risk of dementia: a longitudinal study

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