Author + information
- Received December 14, 2018
- Revision received April 9, 2019
- Accepted May 7, 2019
- Published online July 22, 2019.
- Ning Ding, MBBS, ScMa,
- Yingying Sang, MSa,
- Jingsha Chen, MSa,
- Shoshana H. Ballew, PhDa,
- Corey A. Kalbaugh, PhDb,
- Maya J. Salameh, MDc,
- Michael J. Blaha, MD, MPHc,
- Matthew Allison, MD, MPHd,
- Gerardo Heiss, MD, PhDe,
- Elizabeth Selvin, PhD, MPHa,c,
- Josef Coresh, MD, PhDa,c and
- Kunihiro Matsushita, MD, PhDa,c,∗ (, )@KuniMatsushita
- aJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- bUniversity of North Carolina at Chapel Hill Department of Surgery, Chapel Hill, North Carolina
- cJohns Hopkins University School of Medicine, Baltimore, Maryland
- dUniversity of California San Diego School of Medicine, La Jolla, California
- eUniversity of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
- ↵∗Address for correspondence:
Dr. Kunihiro Matsushita, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Suite 2-600, Baltimore, Maryland 21287.
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.
The ARIC study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (contract nos. HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN2682017000021). Dr. Salameh has served on the Advisory Board for Bristol-Myers Squibb. Dr. Matsushita has been supported by a grant from the National Heart, Lung, and Blood Institute (R21HL133694); and has received research funding and personal fees from Fukuda Denshi (outside of the work). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received December 14, 2018.
- Revision received April 9, 2019.
- Accepted May 7, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.