Published Online
on July 18, 2005

A more recent version of this article appeared on July 26, 2005

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Submitted on November 15, 2004
Revised on March 29, 2005
Accepted on March 31, 2005

Role of Smoking in Global and Regional Cardiovascular Mortality

Majid Ezzati PhD^*, S. Jane Henley MSPH, Michael J. Thun MD, and 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.).

^* To whom correspondence should be addressed. E-mail: mezzati{at}hsph.harvard.edu.

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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