Differential impact of smoking on cardiac or non-cardiac death according to age

Autoři: Wonsuk Choi aff001;  Sun-Hwa Kim aff001;  Si-Hyuck Kang aff001;  Jin Joo Park aff001;  Chang-Hwan Yoon aff001;  Tae-Jin Youn aff001;  In-Ho Chae aff001
Působiště autorů: Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224486


Tobacco smoking causes cardiovascular diseases, lung disease, and various cancers. Understanding the population-based characteristics associated with smoking and the cause of death is important to improve survival. This study sought to evaluate the differential impact of smoking on cardiac or non-cardiac death according to age. Data from 514,866 healthy adults who underwent national health screening in South Korea were analyzed. The participants were divided into three groups: never-smoker, ex-smoker or current smoker according to the smoking status. The incidence rates and hazard ratios (HRs) of cardiac or non-cardiac deaths according to smoking status and age groups during the 10-year follow-up were calculated to evaluate the differential risk of smoking. Over the follow-up period, 6,192 and 24,443 cardiac and non-cardiac deaths had occurred, respectively. The estimated incidence rate of cardiac and non-cardiac death gradually increased in older age groups and was higher in current smokers and ex-smokers than that in never-smokers among all age groups. After adjustment of covariates, the HRs for cardiac death of current smokers compared to never-smokers were the highest in individuals in their 40’s (1.82; 95% CI, 1.45–2.28); this gradually decreased to 0.96 (95% CI, 0.67–1.38) in individuals >80 years. In contrast, the HRs for non-cardiac death peaked in individuals in their 50’s, (HR 1.69, 95% CI 1.57–1.82) and was sustained in those >80 years (HR 1.40, 95% CI 1.17–1.69). Ex-smokers did not show elevated risk of cardiac death compared to never-smokers in any age group, whereas they showed significantly higher risk of non-cardiac death in their 60’s and 70’s (HR, 1.29; 95% CI, 1.19–1.39; HR 1.22, 95% CI, 1.12–1.32, respectively). Acute myocardial infarction and lung cancer showed patterns similar to those of cardiac and non-cardiac death, respectively. Smoking was associated with higher relative risk of cardiac death in the middle-aged group and non-cardiac death in the older age group. Ex-smokers in the older age group had elevated risk of non-cardiac death. To prevent early cardiac death and late non-cardiac death, smoking cessation should be emphasized as early as possible.

Klíčová slova:

Age groups – Cardiovascular diseases – Death rates – Health insurance – Lung and intrathoracic tumors – Myocardial infarction – Smoking habits


1. West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health. 2017;32(8):1018–36. doi: 10.1080/08870446.2017.1325890 28553727

2. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Publications and Reports of the Surgeon General. Atlanta (GA)2010.

3. Dawber TR, Kannel WB, Revotskie N, Kagan A. The epidemiology of coronary heart disease—the Framingham enquiry. Proc R Soc Med. 1962;55:265–71. 13884013

4. Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Eur J Prev Cardiol. 2018:2047487318806658.

5. Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2018;33(6):509–21. doi: 10.1007/s10654-017-0351-y 29417317

6. Shah RS, Cole JW. Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther. 2010;8(7):917–32. doi: 10.1586/erc.10.56 20602553

7. Hackshaw A, Morris JK, Boniface S, Tang JL, Milenkovic D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;360:j5855. doi: 10.1136/bmj.j5855 29367388

8. Mons U, Muezzinler A, Gellert C, Schottker B, Abnet CC, Bobak M, et al. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ. 2015;350:h1551. doi: 10.1136/bmj.h1551 25896935

9. Mahonen MS, McElduff P, Dobson AJ, Kuulasmaa KA, Evans AE, Project WM. Current smoking and the risk of non-fatal myocardial infarction in the WHO MONICA Project populations. Tob Control. 2004;13(3):244–50. doi: 10.1136/tc.2003.003269 15333879

10. Hansen EF, Andersen LT, Von Eyben FE. Cigarette smoking and age at first acute myocardial infarction, and influence of gender and extent of smoking. Am J Cardiol. 1993;71(16):1439–42. doi: 10.1016/0002-9149(93)90608-f 8517392

11. Gourlay SG, Rundle AC, Barron HV. Smoking and mortality following acute myocardial infarction: results from the National Registry of Myocardial Infarction 2 (NRMI 2). Nicotine Tob Res. 2002;4(1):101–7. doi: 10.1080/14622200110103205 11906686

12. Gleerup HB, Dahm CC, Thim T, Jensen SE, Jensen LO, Kristensen SD, et al. Smoking is the dominating modifiable risk factor in younger patients with STEMI. Eur Heart J Acute Cardiovasc Care. 2018:2048872618810414.

13. Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385. doi: 10.1186/1471-2407-12-385 22943444

14. Seong SC, Kim YY, Park SK, Khang YH, Kim HC, Park JH, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open. 2017;7(9):e016640. doi: 10.1136/bmjopen-2017-016640 28947447

15. Himbert D, Klutman M, Steg G, White K, Gulba DC, Investigators G. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol. 2005;100(1):109–17. doi: 10.1016/j.ijcard.2004.10.004 15820293

16. Larsen GK, Seth M, Gurm HS. The ongoing importance of smoking as a powerful risk factor for ST-segment elevation myocardial infarction in young patients. JAMA Intern Med. 2013;173(13):1261–2. doi: 10.1001/jamainternmed.2013.6075 23712862

17. Lloyd A, Steele L, Fotheringham J, Iqbal J, Sultan A, Teare MD, et al. Pronounced increase in risk of acute ST-segment elevation myocardial infarction in younger smokers. Heart. 2017;103(8):586–91. doi: 10.1136/heartjnl-2016-309595 27899428

18. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004;43(10):1731–7. doi: 10.1016/j.jacc.2003.12.047 15145091

19. Bolorunduro O, Cushman C, Kapoor D, Alexander K, Cuellar-Silva J, Giri S, et al. Comparison of Coronary Atherosclerotic Plaque Burden and Composition of Culprit Lesions Between Cigarette Smokers and Non-Smokers by In Vivo Virtual Histology Intravascular Ultrasound. J Invasive Cardiol. 2015;27(8):354–8. 25999135

20. Wang XL, Greco M, Sim AS, Duarte N, Wang J, Wilcken DE. Effect of CYP1A1 MspI polymorphism on cigarette smoking related coronary artery disease and diabetes. Atherosclerosis. 2002;162(2):391–7. doi: 10.1016/s0021-9150(01)00723-7 11996959

21. Wang XL, Sim AS, Wang MX, Murrell GA, Trudinger B, Wang J. Genotype dependent and cigarette specific effects on endothelial nitric oxide synthase gene expression and enzyme activity. FEBS Lett. 2000;471(1):45–50. doi: 10.1016/s0014-5793(00)01356-9 10760510

22. Robinson K, Conroy RM, Mulcahy R. When does the risk of acute coronary heart disease in ex-smokers fall to that in non-smokers? A retrospective study of patients admitted to hospital with a first episode of myocardial infarction or unstable angina. Br Heart J. 1989;62(1):16–9. doi: 10.1136/hrt.62.1.16 2757869

23. Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y, Israel Study Group on First Acute Myocardial I. Smoking status and long-term survival after first acute myocardial infarction a population-based cohort study. J Am Coll Cardiol. 2009;54(25):2382–7. doi: 10.1016/j.jacc.2009.09.020 20082928

24. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86–97. doi: 10.1001/jama.290.1.86 12837716

25. Zhu S, Melcer T, Sun J, Rosbrook B, Pierce JP. Smoking cessation with and without assistance: a population-based analysis. Am J Prev Med. 2000;18(4):305–11. 10788733

26. Sandhu RK, Jimenez MC, Chiuve SE, Fitzgerald KC, Kenfield SA, Tedrow UB, et al. Smoking, smoking cessation, and risk of sudden cardiac death in women. Circ Arrhythm Electrophysiol. 2012;5(6):1091–7. doi: 10.1161/CIRCEP.112.975219 23233741

27. Pope CA 3rd, Burnett RT, Turner MC, Cohen A, Krewski D, Jerrett M, et al. Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure-response relationships. Environ Health Perspect. 2011;119(11):1616–21. doi: 10.1289/ehp.1103639 21768054

28. Hecht SS, Szabo E. Fifty years of tobacco carcinogenesis research: from mechanisms to early detection and prevention of lung cancer. Cancer prevention research. 2014;7(1):1–8. doi: 10.1158/1940-6207.CAPR-13-0371 24403288

29. Govindan R, Ding L, Griffith M, Subramanian J, Dees ND, Kanchi KL, et al. Genomic landscape of non-small cell lung cancer in smokers and never-smokers. Cell. 2012;150(6):1121–34. doi: 10.1016/j.cell.2012.08.024 22980976

30. Lim MT, Sung HN, J. SH, Kim SG, Chang DM, Pack HJ, et al. Smoking and Health-Related Quality of Life among Korean Adults. Korean J Fam Pract. 2015;5(2):135–42.

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