Amiya A Ahmed1, Kanan Patel1, Margaret A Nyaku1, Raya E Kheirbek1, Vera Bittner1, Gregg C Fonarow1, Gerasimos S Filippatos1, Charity J Morgan1, Inmaculada B Aban1, Marjan Mujib1, Ravi V Desai1, Richard M Allman1, Michel White1, Prakash Deedwania1, George Howard1, Robert O Bonow1, Ross D Fletcher1, Wilbert S Aronow1, Ali Ahmed2. 1. From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.). 2. From the Departments of Biology (A.A.A.), Medicine (M.A.N., V.B., A.A.), and Biostatistics (C.J.M., I.B.A., G.H.), University of Alabama at Birmingham; Department of Medicine, University of California, San Francisco (K.P.); Center for Health and Aging and Office of the Chief of Staff, Washington DC Veterans Affairs Medical Center (A.A., R.E.K., R.D.F.); Department of Medicine, George Washington University, Washington, DC (R.E.K.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Athens, Athens, Greece (G.S.F.); Department of Medicine, New York Medical College, Valhalla (M.M., W.S.A.); Department of Medicine, Lehigh Valley Hospital, Allentown, PA (R.V.D.); Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington DC (R.M.A.); Department of Medicine, University of Montreal, Montreal, QC, Canada (M.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); and Department of Medicine, Northwestern University, Chicago, IL (R.O.B.). aliahmedmdmph@gmail.com.
Abstract
BACKGROUND: According to the 2004 Surgeon General's Report on Health Consequences of Smoking, after >15 years of abstinence, the cardiovascular risk of former smokers becomes similar to that of never-smokers. Whether this health benefit of smoking cessation varies by amount and duration of prior smoking remains unclear. METHODS AND RESULTS: Of the 4482 adults ≥65 years without prevalent heart failure (HF) in the Cardiovascular Health Study, 2556 were never-smokers, 629 current smokers, and 1297 former smokers with >15 years of cessation, of whom 312 were heavy smokers (highest quartile; ≥32 pack-years). Age-sex-race-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for centrally adjudicated incident HF and mortality during 13 years of follow-up were estimated using Cox regression models. Compared with never-smokers, former smokers as a group had similar risk for incident HF (aHR, 0.99; 95% CI, 0.85-1.16) and all-cause mortality (aHR, 1.08; 95% CI, 0.96-1.20), but former heavy smokers had higher risk for both HF (aHR, 1.45; 95% CI, 1.15-1.83) and mortality (aHR, 1.38; 95% CI, 1.17-1.64). However, when compared with current smokers, former heavy smokers had lower risk of death (aHR, 0.64; 95% CI, 0.53-0.77), but not of HF (aHR, 0.97; 95% CI, 0.74-1.28). CONCLUSIONS: After >15 years of smoking cessation, the risk of HF and death for most former smokers becomes similar to that of never-smokers. Although this benefit of smoking cessation is not extended to those with ≥32 pack-years of prior smoking, they have lower risk of death relative to current smokers.
BACKGROUND: According to the 2004 Surgeon General's Report on Health Consequences of Smoking, after >15 years of abstinence, the cardiovascular risk of former smokers becomes similar to that of never-smokers. Whether this health benefit of smoking cessation varies by amount and duration of prior smoking remains unclear. METHODS AND RESULTS: Of the 4482 adults ≥65 years without prevalent heart failure (HF) in the Cardiovascular Health Study, 2556 were never-smokers, 629 current smokers, and 1297 former smokers with >15 years of cessation, of whom 312 were heavy smokers (highest quartile; ≥32 pack-years). Age-sex-race-adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for centrally adjudicated incident HF and mortality during 13 years of follow-up were estimated using Cox regression models. Compared with never-smokers, former smokers as a group had similar risk for incident HF (aHR, 0.99; 95% CI, 0.85-1.16) and all-cause mortality (aHR, 1.08; 95% CI, 0.96-1.20), but former heavy smokers had higher risk for both HF (aHR, 1.45; 95% CI, 1.15-1.83) and mortality (aHR, 1.38; 95% CI, 1.17-1.64). However, when compared with current smokers, former heavy smokers had lower risk of death (aHR, 0.64; 95% CI, 0.53-0.77), but not of HF (aHR, 0.97; 95% CI, 0.74-1.28). CONCLUSIONS: After >15 years of smoking cessation, the risk of HF and death for most former smokers becomes similar to that of never-smokers. Although this benefit of smoking cessation is not extended to those with ≥32 pack-years of prior smoking, they have lower risk of death relative to current smokers.
Authors: G Howard; L E Wagenknecht; G L Burke; A Diez-Roux; G W Evans; P McGovern; F J Nieto; G S Tell Journal: JAMA Date: 1998-01-14 Impact factor: 56.272
Authors: Kolawole S Okuyemi; Janet L Thomas; Jennifer Warren; Hongfei Guo; Jasjit S Ahluwalia Journal: Nicotine Tob Res Date: 2010-09-09 Impact factor: 4.244
Authors: Gina D Schellenbaum; Thomas D Rea; Susan R Heckbert; Nicholas L Smith; Thomas Lumley; Veronique L Roger; Dalane W Kitzman; Herman A Taylor; Daniel Levy; Bruce M Psaty Journal: Am J Epidemiol Date: 2004-10-01 Impact factor: 4.897
Authors: I Kawachi; G A Colditz; M J Stampfer; W C Willett; J E Manson; B Rosner; D J Hunter; C H Hennekens; F E Speizer Journal: Ann Intern Med Date: 1993-11-15 Impact factor: 25.391
Authors: Megan Watson; Zeina Dardari; Sina Kianoush; Michael E Hall; Andrew P DeFilippis; Rachel J Keith; Emelia J Benjamin; Carlos J Rodriguez; Aruni Bhatnagar; Joao A Lima; Javed Butler; Michael J Blaha; Mahmoud Al Rifai Journal: Am J Cardiol Date: 2019-03-18 Impact factor: 2.778
Authors: Meredith S Duncan; Matthew S Freiberg; Robert A Greevy; Suman Kundu; Ramachandran S Vasan; Hilary A Tindle Journal: JAMA Date: 2019-08-20 Impact factor: 56.272
Authors: Daisuke Kamimura; Loretta R Cain; Robert J Mentz; Wendy B White; Michael J Blaha; Andrew P DeFilippis; Ervin R Fox; Carlos J Rodriguez; Rachel J Keith; Emelia J Benjamin; Javed Butler; Aruni Bhatnagar; Rose M Robertson; Michael D Winniford; Adolfo Correa; Michael E Hall Journal: Circulation Date: 2018-04-16 Impact factor: 29.690
Authors: Charles Faselis; Joel A Nations; Charity J Morgan; Jared Antevil; Jeffrey M Roseman; Sijian Zhang; Gregg C Fonarow; Helen M Sheriff; Gregory D Trachiotis; Richard M Allman; Prakash Deedwania; Qing Zeng-Trietler; Daniel D Taub; Amiya A Ahmed; George Howard; Ali Ahmed Journal: JAMA Oncol Date: 2022-10-01 Impact factor: 33.006
Authors: Daniel J Conklin; Suzaynn Schick; Michael J Blaha; Alex Carll; Andrew DeFilippis; Peter Ganz; Michael E Hall; Naomi Hamburg; Tim O'Toole; Lindsay Reynolds; Sanjay Srivastava; Aruni Bhatnagar Journal: Am J Physiol Heart Circ Physiol Date: 2019-02-01 Impact factor: 4.733
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2019-03-17 Impact factor: 24.094
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: Circulation Date: 2019-03-17 Impact factor: 29.690
Authors: Katherine B Malcolm; Danya L Dinwoodey; Michael C Cundiff; Shawn M Regis; Andrea K Borondy Kitts; Christoph Wald; Miranda L Lynch; Wael Al-Husami; Andrea B McKee; Brady J McKee Journal: J Thorac Dis Date: 2018-05 Impact factor: 2.895