Abstract P074: Smoking Status and Incidence of Cancer After Myocardial Infarction: a 20-year Follow-up Study
Objectives: We compared cancer incidence after acute myocardial infarction (MI) of never smokers, pre-MI quitters, post-MI quitters and persistent smokers, and assessed whether cigarette reduction among continued smokers is associated with lower cancer risk.
Methods: Consecutive patients aged ≤65 years discharged from 8 hospitals in central Israel after first MI in 1992-3 were followed for cancer through 2013. Extensive data, including self-reported smoking habits, were obtained at the index hospitalization and 4 times during follow-up. Cox proportional hazards and Fine & Gray competing risks models were constructed to assess the hazard ratios (HRs) for cancer associated with baseline smoking categories. Smoking categories were also modeled as time-varying variables using extended Cox models.
Results: Overall, 1,486 cancer-free participants at baseline were studies (mean±SD age, 54±8 years; 81% male). Smokers were younger than nonsmokers and more likely to be male and of lower socioeconomic status. Over a median follow-up of 21.4 years, 273 incident cancers were diagnosed. Baseline smoking was associated with ~40% increased risk of cancer; ~25% after accounting for death as a competing event. Taking changes in smoking during follow-up into account, the increased risk was largely confined to persistent smokers, whereas the risk in post-MI quitters was close to that of never smokers (Figure). Among patients who continued smoking after MI, each reduction of 10 cigarettes relative to pre-MI consumption was associated with an adjusted HR of 0.86 (95% CI: 0.74-1.00).
Conclusions: Smoking cessation either before or after MI is associated with lower risk of cancer. Reducing consumption among persistent smokers appears also to be beneficial.
Author Disclosures: Y. Gerber: None. K. Lotan: None. U. Goldbourt: None.
- © 2017 by American Heart Association, Inc.