Dataset Information

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

ABSTRACT:

Background

It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation.

Methods

Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health records in England, covering primary care, hospitalizations, myocardial infarction (MI) registry and cause-specific mortality (the CALIBER programme).

Results

During 11.6 million person-years of follow-up, 114859 people had an initial non-fatal or fatal CVD presentation. By age 90 years, current vs never smokers' lifetime risks varied from 0.4% vs 0.2% for subarachnoid haemorrhage (SAH), to 8.9% vs 2.6% for peripheral arterial disease (PAD). Current smoking showed no association with cardiac arrest or sudden cardiac death [hazard ratio (HR)=1.04, 95% confidence interval (CI) 0.91-1.19).The strength of association differed markedly according to disease type: stable angina (HR=1.08, 95% CI 1.01-1.15),transient ischaemic attack (HR=1.41, 95% CI 1.28-1.55), unstable angina (HR=1.54, 95% CI 1.38-1.72), intracerebral haemorrhage (HR=1.61, 95% CI 1.37-1.89), heart failure (HR=1.62, 95% CI 1.47-1.79), ischaemic stroke (HR=1.90, 95% CI 1.72-2.10), MI (HR=2.32, 95% CI 2.20-2.45), SAH (HR= 2.70, 95% CI 2.27-3.21), PAD (HR=5.16, 95% CI 4.80-5.54) and abdominal aortic aneurysm (AAA) (HR=5.18, 95% CI 4.61-5.82). Population-attributable fractions were lower for women than men for unheralded coronary death, ischaemic stroke, PAD and AAA. Ten years after quitting smoking, the risks of PAD, AAA (in men) and unheralded coronary death remained increased (HR=1.36, 1.47 and 2.74, respectively).

Conclusions

The heterogeneous associations of smoking with different CVD presentations suggests different underlying mechanisms and have important implications for research, clinical screening and risk prediction.

SUBMITTER: Pujades-Rodriguez M

PROVIDER: S-EPMC4339760 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Publications

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

Pujades-Rodriguez Mar M George Julie J Shah Anoop Dinesh AD Rapsomaniki Eleni E Denaxas Spiros S West Robert R Smeeth Liam L Timmis Adam A Hemingway Harry H

International journal of epidemiology 20141120 1

<h4>Background</h4>It is not known how smoking affects the initial presentation of a wide range of chronic and acute cardiovascular diseases (CVDs), nor the extent to which associations are heterogeneous. We estimated the lifetime cumulative incidence of 12 CVD presentations, and examined associations with smoking and smoking cessation.<h4>Methods</h4>Cohort study of 1.93 million people aged ≥30years, with no history of CVD, in 1997-2010. Individuals were drawn from linked electronic health reco ...[more]

PMID: 25416721

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Project description:BackgroundThe associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease.MethodsWe used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371.FindingsDuring 5·2 years median follow-up, we recorded 83,098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90-114 mm Hg and diastolic blood pressure of 60-74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32-1·58]), subarachnoid haemorrhage (1·43 [1·25-1·63]), and stable angina (1·41 [1·36-1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00-1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86-0·98]) and strongest for peripheral arterial disease (1·23 [1·20-1·27]). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9-63·8) compared with 46·1% (45·5-46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8-5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years.InterpretationThe widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them.FundingMedical Research Council, National Institute for Health Research, and Wellcome Trust.

Project description:BackgroundThe lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults.MethodsWe conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event.ResultsWe observed marked differences in the lifetime risks of cardiovascular disease across risk-factor strata. Among participants who were 55 years of age, those with an optimal risk-factor profile (total cholesterol level, <180 mg per deciliter [4.7 mmol per liter]; blood pressure, <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk-factor strata were observed among blacks and whites and across diverse birth cohorts.ConclusionsDifferences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.).

Project description:ImportanceA wide range of medications, noncombustible nicotine products, behavioral support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness outside of clinical trial settings can support informed decision-making.ObjectivesTo provide up-to-date estimates of the prevalence of different smoking cessation aids and associations with quit success and to explore moderation by socioeconomic position.Design, setting, and participantsThis survey study used data from the Smoking Toolkit Study, a monthly cross-sectional household survey, conducted from 2006 to 2024 in England, UK. Participants were individuals aged at least 16 years who reported trying to quit smoking in the past year. Analyses were conducted from July to November 2024.Main outcomes and measuresThe outcome variable was self-reported success in quitting smoking from the start of the most recent quit attempt up to the time of survey (hereafter, quit success). Independent variables were use (yes or no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT), obtained via prescription or over-the-counter; varenicline; bupropion; electronic cigarettes (e-cigarettes); face-to-face behavioral support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); and nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt.ResultsA total of 25 094 participants (mean [SD] age, 38.7 [15.3] years; 51.5% [95% CI, 50.8%-52.2%] men) were included. In 2023 to 2024, the most used aids were e-cigarettes (40.2% [95% CI, 37.6%-42.8%]) and over-the-counter NRT (17.3% [95% CI, 15.3%-19.2%]); 40.8% (95% CI, 38.2%-43.4%) of quit attempts were unaided. While e-cigarette use was associated with higher odds of quit success after adjustment for use of other aids and covariates (odds ratio [OR], 1.95 [95% CI, 1.74-2.17]), use of over-the-counter NRT was not (OR, 1.03 [95% CI, 0.93-1.15]). Other aids positively associated with quit success were websites (used by 4.6% [95% CI, 3.5%-5.7%] in 2023-2024; OR, 1.43 [95% CI, 1.03-1.98]), prescription NRT (used by 4.5% [95% CI, 3.4%-5.5%] in 2023-2024; OR, 1.33 [95% CI, 1.12-1.58]), varenicline (used by 1.1% [95% CI, 0.5%-1.7%] in 2023-2024; OR, 1.80 [95% CI, 1.50-2.18]), and HTPs (used by 0.7% [95% CI, 0.3%-1.1%] in 2023-2024; OR, 2.37 [95% CI, 1.24-4.51]). Face-to-face behavioral support (used by 2.2% [95% CI, 1.5-2.9] in 2023-2024) was associated with higher odds of quit success among those from less advantaged (OR, 1.59 [95% CI, 1.19-2.14]) but not more advantaged (OR, 0.91 [95% CI, 0.65-1.29]) socioeconomic positions. There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive.Conclusions and relevanceThis cross-sectional study found that while a range of effective smoking cessation aids are available in England, many people tried to quit using less effective forms of support or none at all. Quit success rates could be improved by encouraging people to use more effective methods.

Project description:IntroductionStudies consistently demonstrate smoking is a socially contagious behavior, but less is known about the influence of social connections on vaping. This study examined associations between having close social connections who smoke or vape and relevant smoking and vaping outcomes.Aims and methodsThis was a representative cross-sectional survey of adults (≥16 years) in England. Participants (n = 1618) were asked how many people they discuss important matters with (ie, close social connections) and how many of them smoke/vape. We tested associations between (1) smoking and (2) vaping among close social connections and participants' own smoking and vaping status; harm perceptions of e-cigarettes (among current smokers); attempts and success in quitting smoking (among past-year smokers); and use of e-cigarettes as a smoking cessation aid (among past-year smokers who tried to quit).ResultsAdults with ≥1 close social connection who smoke were more likely than those with none to smoke themselves (32.8% vs. 9.4%; ORadj = 7.23[95% CI: 4.74 to 11.0]) and had an uncertain lower likelihood to quit (12.2% vs. 19.8%; ORadj = 0.46[0.17-1.23]). Those with ≥1 close social connection who vape were more likely than those with none to vape themselves (29.6% vs. 6.3%; ORadj = 5.16[3.15-8.43]) and to use e-cigarettes in their most recent attempt to quit (57.0% vs. 27.9%; ORadj = 18.0[1.80-181]), and had an uncertain higher likelihood to perceive e-cigarettes as less harmful than cigarettes (30.8% vs. 12.2%; ORadj = 2.37[0.82-6.90]).ConclusionsIn England, we replicated well-established associations with smoking and found similar evidence for vaping. People were much more likely to vape and to use e-cigarettes to quit smoking if they had close social connections who vaped.ImplicationsThe cross-sectional design means it is not clear whether smoking/vaping among close social connections influences people to smoke/vape themselves, or whether people who smoke/vape select to form close social connections with others who similarly smoke/vape. Further research is required to establish causality. If the associations we observed are causal, interventions that encourage smokers to switch to vaping may have positive spillover effects on social connections' perceptions of e-cigarettes and the use of these products to support smoking cessation.

Project description:Background and aimsWhereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England.DesignIndirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths.SettingEngland, 2000-2019.ParticipantsNationally representative sample of population.MeasurementsEngland's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies.FindingsBetween 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results.ConclusionsAn indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.

Dataset Information

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

Background

Methods

Results

Conclusions

Publications

Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1937360 people in England: lifetime risks and implications for risk prediction.

Similar Datasets

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