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Cigarette Smoking, Smoking Cessation, and Long-Term Risk of 3 Major Atherosclerotic Diseases
Ning Ding1, Yingying Sang1, Jingsha Chen1
1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Smoking significantly increases the risk of peripheral artery disease (PAD), coronary heart disease (CHD), and stroke. Quitting smoking reduces this risk, but elevated risk for PAD persists for up to 30 years.
Area of Science:
- Cardiovascular epidemiology
- Atherosclerosis research
- Public health
Background:
- Public health messaging on smoking's cardiovascular impact often overlooks peripheral artery disease (PAD).
- Limited research comprehensively compares smoking's long-term effects on PAD, coronary heart disease (CHD), and stroke.
- Smoking is a known, significant risk factor for PAD.
Purpose of the Study:
- To quantify the long-term association between cigarette smoking and its cessation with the incidence of PAD, CHD, and stroke.
- To compare the strength of association for smoking and cessation across these three major atherosclerotic diseases.
Main Methods:
- Analysis of 13,355 participants from the Atherosclerosis Risk In Communities (ARIC) study (aged 45-64 at baseline).
- Cox models used to assess associations between smoking parameters (pack-years, duration, intensity, cessation) and incident PAD, CHD, and stroke.
- Follow-up median of 26 years.
Main Results:
- A dose-response relationship was observed between smoking pack-years and all three outcomes, with the strongest association for PAD.
- Smoking cessation consistently lowered the risk of PAD, CHD, and stroke.
- Elevated risk for PAD persisted up to 30 years post-cessation, and for CHD up to 20 years.
Conclusions:
- Smoking is strongly associated with PAD, CHD, and stroke, with the most pronounced effect on PAD incidence.
- The risk associated with smoking persists for decades after cessation, particularly for PAD.
- Public health initiatives should emphasize smoking prevention and early cessation, incorporating PAD into cardiovascular risk communication.
Background:
Public statements about the effect of smoking on cardiovascular disease are predominantly based on investigations of coronary heart disease (CHD) and stroke, although smoking is recognized as a strong risk factor for peripheral artery disease (PAD). No study has comprehensively compared the long-term association of cigarette smoking and its cessation with the incidence of 3 major atherosclerotic diseases (PAD, CHD, and stroke).
Objectives:
The aim of this study was to quantify the long-term association of cigarette smoking and its cessation with the incidence of the 3 outcomes.
Methods:
A total of 13,355 participants aged 45 to 64 years in the ARIC (Atherosclerosis Risk In Communities) study without PAD, CHD, or stroke at baseline (1987 to 1989) were included. The associations of smoking parameters (pack-years, duration, intensity, and cessation) with incident PAD were quantified and contrasted with CHD and stroke using Cox models.
Results:
Over a median follow-up of 26 years, there were 492 PAD cases, 1,798 CHD cases, and 1,106 stroke cases. A dose-response relationship was identified between pack-years of smoking and 3 outcomes, with the strongest results for PAD. The pattern was consistent when investigating duration and intensity separately. A longer period of smoking cessation was consistently related to lower risk of PAD, CHD, and stroke, but a significantly elevated risk persisted up to 30 years following smoking cessation for PAD and up to 20 years for CHD.
Conclusions:
All smoking measures showed significant associations with 3 major atherosclerotic diseases, with the strongest effect size for incident PAD. The risk due to smoking lasted up to 30 years for PAD and 20 years for CHD. Our results further highlight the importance of smoking prevention and early smoking cessation, and indicate the need for public statements to take PAD into account when acknowledging the impact of smoking on overall cardiovascular health.
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