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(Circulation. 2005;112:489-497.)
© 2005 American Heart Association, Inc.

Epidemiology

Role of Smoking in Global and Regional Cardiovascular Mortality

Majid Ezzati, PhD; S. Jane Henley, MSPH; Michael J. Thun, MD; Alan D. Lopez, PhD

From Harvard School of Public Health, Boston, Mass (M.E.); American Cancer Society, Atlanta, Ga (S.J.H., M.J.T.); and School of Population Health, University of Queensland, Brisbane, Australia (A.D.L.).

Correspondence to Dr Majid Ezzati, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115. E-mail mezzati{at}hsph.harvard.edu

Received November 15, 2004; revision received March 29, 2005; accepted March 31, 2005.

Background— Smoking is a major cause of cardiovascular disease mortality. There is little information on how it contributes to global and regional cause-specific mortality from cardiovascular diseases for which background risk varies because of other risks.

Method and Results— We used data from the American Cancer Society’s Cancer Prevention Study II (CPS II) and the World Health Organization Global Burden of Disease mortality database to estimate smoking-attributable deaths from ischemic heart disease, cerebrovascular disease, and a cluster of other cardiovascular diseases for 14 epidemiological subregions of the world by age and sex. We used lung cancer mortality as an indirect marker for accumulated smoking hazard. CPS-II hazards were adjusted for important covariates. In the year 2000, an estimated 1.62 (95% CI, 1.27 to 2.04) million cardiovascular deaths in the world, 11% of total global cardiovascular deaths, were due to smoking. Of these, 1.17 million deaths were among men and 450 000 among women. There were 670 000 (95% CI, 440 000 to 920 000) smoking-attributable cardiovascular deaths in the developing world and 960 000 (95% CI, 770 000 to 1 200 000) in industrialized regions. Ischemic heart disease accounted for 54% of smoking-attributable cardiovascular mortality, followed by cerebrovascular disease (25%). There was variability across regions in the role of smoking as a cause of various cardiovascular diseases.

Conclusions— More than 1 in every 10 cardiovascular deaths in the world in the year 2000 were attributable to smoking, demonstrating that it is an important preventable cause of cardiovascular mortality.

Key Words: cardiovascular diseases • health • mortality • risk factors • smoking

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