CVD risk increase persists for decades after smoking cessation

  • J Am Coll Cardiol

  • International Clinical Digest
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Takeaway

  • Smoking-related risk increases in atherosclerotic disease can persist decades after smoking cessation.
  • Risk for peripheral artery disease (PAD) is especially long-lasting.
  • Declines in risk for PAD, coronary heart disease (CHD), and stroke do begin within 5 years of smoking cessation, overall.

Why this matters

  • Editorial: the results serve as a reminder to clinicians that treating tobacco use is crucial.
    • Notes American College of Cardiology’s consensus document on actions clinicians can take to promote smoking cessation.

Key results

  • Pack-years of smoking were tied to all 3 outcomes, for duration and intensity, especially for PAD.
  • Vs never-smokers, PAD risk was almost quadrupled for those with ≥40 pack-years.

  • CHD risk doubled for that level of smoking, and almost doubled for stroke.
  • PAD risk remained elevated up to 30 years; risk for CHD up to 20 years.

  • PAD emerged in all analyses as being most strongly associated with smoking, among the 3 outcomes.
  • Younger quitters had lower risks for all 3.

Study design

  • 13,355 participants, ages 45-64 years, in Atherosclerosis Risk in Communities study.
  • No PAD, CHD, stroke at baseline.
  • Associations with pack-years, duration, intensity, cessation assessed.
  • Funding: NIH, others.

Limitations

  • Mild PAD cases likely missed because identification was based on PAD-related hospitalization.