Abstract 1042: Lifetime Risks for Cardiovascular and Non-Cardiovascular Disease Endpoints by Smoking Status in Men and Women at Selected Ages: The Cardiovascular Lifetime Risk Pooling Project
BACKGROUND: Tobacco use is a well-known short- and long-term risk factor for cardiovascular disease (CVD). Smoking has also been established as a risk factor for non-CVD competing causes of death. We sought to further characterize the association of smoking status with lifetime risk (LR) for CVD and non-CVD endpoints in the framework of competing risks.
METHODS: Using data from the NHLBI public release as well as internal datasets, participants (ppts) from 16 US epidemiologic cohort studies were pooled and stratified by sex and current smoking status at index ages 45, 55, and 65 years. LRs for CVD death, CHD death/non-fatal myocardial infarction (NFMI), fatal/non-fatal stroke and non-CVD death to age 95 years were estimated, with death free of the outcome of interest as a competing event. Competing Cox models were also used to identify the first CVD events.
RESULTS: In all, ppts contributed 50,609 male and 34,060 female person-exams and up to 1,246,530 person-years of follow-up. Data for LRs for CHD death/NFMI and non-CVD death are shown in the table⇓. LR for CVD endpoints, to age 95, is similar for smokers and non-smokers at all index ages. However, smokers have their events much earlier. For example, LR for CVD death to age 70 for a 45 year old smoking man is 12.3% compared to 6.8% for a non-smoker, and non-smokers reach the same level of risk 7 years later. LR for non-CVD death is higher than CVD death, especially in smokers. Median survival for smokers is 2–7 years shorter than non-smokers. Finally, in men, any CVD endpoint occurs as a first event more frequently than non-CVD death. In women, the reverse is true.
CONCLUSIONS: Though overall lifetime risk for CVD endpoints is similar for smokers and non-smokers, smokers have their events substantially earlier. Smokers also have greater competing causes of death and much shorter median survival than non-smokers. Consideration of smoking-related CVD and competing risks are essential for public health efforts at smoking cessation.