Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking.

Pubmed ID: 26038535

Pubmed Central ID: PMC5499230

Journal: Circulation. Heart failure

Publication Date: July 1, 2015

Affiliation: 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.

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Smoking, Risk Assessment, Proportional Hazards Models, Heart Failure, Multivariate Analysis, Prospective Studies, Chi-Square Distribution, Prognosis, Incidence, Time Factors, Smoking Cessation, Smoking Prevention

Grants: R01 HL085561, R01-HL085561, R01 HL097047, R01-HL097047

Authors: White M, Aronow WS, Ahmed A, Mujib M, Filippatos GS, Howard G, Desai RV, Fonarow GC, Aban IB, Deedwania P, Allman RM, Bittner V, Patel K, Bonow RO, Kheirbek RE, Morgan CJ, Fletcher RD, Ahmed AA, Nyaku MA

Cite As: Ahmed AA, Patel K, Nyaku MA, Kheirbek RE, Bittner V, Fonarow GC, Filippatos GS, Morgan CJ, Aban IB, Mujib M, Desai RV, Allman RM, White M, Deedwania P, Howard G, Bonow RO, Fletcher RD, Aronow WS, Ahmed A. Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking. Circ Heart Fail 2015 Jul;8(4):694-701. Epub 2015 Jun 2.

Studies:

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.