Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study

BMC Medicine

  ^{1    2    3    3    3    3    3    4    5    6} 

[1] 0000 0001 2166 6280, grid.420082.c, Cancer Council NSW, Sydney, Australia;0000 0001 2179 088X, grid.1008.9, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia;0000 0001 2180 7477, grid.1001.0, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, 2601, Acton, ACT, Australia;0000 0001 2180 7477, grid.1001.0, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, 2601, Acton, ACT, Australia;0000 0004 0601 4585, grid.474225.2, The Sax Institute, Sydney, Australia;0000 0004 0469 7714, grid.453005.7, National Heart Foundation of Australia, Melbourne, Australia;0000 0004 1936 8948, grid.4991.5, Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK;0000 0004 1936 8948, grid.4991.5, Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK;

关键词: Cardiovascular disease;    Smoking;    Tobacco;    Ischaemic heart disease;    Coronary heart disease;    Cerebrovascular disease;    Arrhythmia;    Atrial fibrillation;    Heart failure;    Cardiovascular mortality;   

DOI  :  10.1186/s12916-019-1351-4

来源: publisher

【 摘 要 】

BackgroundTobacco smoking is a leading cause of cardiovascular disease (CVD) morbidity and mortality. Evidence on the relation of smoking to different subtypes of CVD, across fatal and non-fatal outcomes, is limited.MethodsA prospective study of 188,167 CVD- and cancer-free individuals aged ≥ 45 years from the Australian general population joining the 45 and Up Study from 2006 to 2009, with linked questionnaire, hospitalisation and death data up to the end of 2015. Hazard ratios (HRs) for hospitalisation with or mortality from CVD among current and past versus never smokers were estimated, including according to intensity and recency of smoking, using Cox regression, adjusting for age, sex, urban/rural residence, alcohol consumption, income and education. Population-attributable fractions were estimated.ResultsDuring a mean 7.2 years follow-up (1.35 million person-years), 27,511 (crude rate 20.4/1000 person-years) incident fatal and non-fatal major CVD events occurred, including 4548 (3.2) acute myocardial infarction (AMI), 3991 (2.8) cerebrovascular disease, 3874 (2.7) heart failure and 2311 (1.6) peripheral arterial disease (PAD) events. At baseline, 8% of participants were current and 34% were past smokers. Of the 36 most common specific CVD subtypes, event rates for 29 were increased significantly in current smokers. Adjusted HRs in current versus never smokers were as follows: 1.63 (95%CI 1.56–1.71) for any major CVD, 2.45 (2.22–2.70) for AMI, 2.16 (1.93–2.42) for cerebrovascular disease, 2.23 (1.96–2.53) for heart failure, 5.06 (4.47–5.74) for PAD, 1.50 (1.24–1.80) for paroxysmal tachycardia, 1.31 (1.20–1.44) for atrial fibrillation/flutter, 1.41 (1.17–1.70) for pulmonary embolism, 2.79 (2.04–3.80) for AMI mortality, 2.26 (1.65–3.10) for cerebrovascular disease mortality and 2.75 (2.37–3.19) for total CVD mortality. CVD risks were elevated at almost all levels of current smoking intensity examined and increased with smoking intensity, with HRs for total CVD mortality in current versus never smokers of 1.92 (1.11–3.32) and 4.90 (3.79–6.34) for 4–6 and ≥ 25 cigarettes/day, respectively. Risks diminished with quitting, with excess risks largely avoided by quitting before age 45. Over one third of CVD deaths and one quarter of acute coronary syndrome hospitalisations in Australia aged < 65 can be attributed to smoking.ConclusionsCurrent smoking increases the risk of virtually all CVD subtypes, at least doubling the risk of many, including AMI, cerebrovascular disease and heart failure. Paroxysmal tachycardia is a newly identified smoking-related risk. Where comparisons are possible, smoking-associated relative risks for fatal and non-fatal outcomes are similar. Quitting reduces the risk substantially. In an established smoking epidemic, with declining and low current smoking prevalence, smoking accounts for a substantial proportion of premature CVD events.

【 授权许可】

CC BY