Objectives: To determine the risk in men and women smoking 1-4 cigarettes per day of dying from specified smoking related diseases and from any cause. Design: Prospective study. Setting: Oslo city and three counties in Norway. Participants: 23 521 men and 19 201 women, aged 35-49 years, screened for cardiovascular disease risk factors in the mid 1970s and followed throughout 2002. Outcomes: Absolute mortality and relative risks adjusted for confounding variables, of dying from ischaemic heart disease, all cancer, lung cancer, and from all causes. Results: Adjusted relative risk (95% confidence interval) in smokers of 1-4 cigarettes per day, with never smokers as reference, of dying from ischaemic heart disease was 2.74 (2.07 to 3.61) in men and 2.94 (1.75 to 4.95) in women. The corresponding figures for all cancer were 1.08 (0.78 to 1.49) and 1.14 (0.84 to 1.55), for lung cancer 2.79 (0.94 to 8.28) and 5.03 (1.81 to 13.98), and for any cause 1.57 (1.33 to 1.85) and 1.47 (1.19 to 1.82). Conclusions: In both sexes, smoking 1-4 cigarettes per day was associated with a significantly higher risk of dying from ischaemic heart disease and from all causes, and from lung cancer in women. Smoking control policymakers and health educators should emphasise more strongly that light smokers also endanger their health. Is there a threshold value for daily cigarette consumption that must be exceeded before serious health consequences occur? Numerous population studies have reported on a strong dose-response relationship between cigarette consumption and severe diseases. In most studies, however, the lowest consumption group was set at 1-9 or 1-15 cigarettes per day. One may argue that smokers in these groups clustered close to the upper limit of this consumption span, and that a threshold value might be found on a lower level.Only a few prospective studies have reported on the health consequences of smoking fewer than five cigarettes per day. [1][2][3] Our aim was to determine the risk in men and women smoking 1-4 cigarettes per day of dying from specified smoking related diseases and from any cause. We report on a Norwegian population of 23 521 men and 19 201 women, aged 35-49 years, who in the mid 1970s were screened for cardiovascular disease risk factors and followed throughout 2002 for deaths from ischaemic heart disease, all cancer, lung cancer, and from all causes. METHODS ParticipantsFrom 1972 to 1978 screening examinations for cardiovascular disease were undertaken in the Norwegian capital, Oslo, and in three Norwegian counties with a mainly rural settlement. In Oslo, all male residents aged 40-49 years were invited, and a 7% random sample of male residents aged 20-39. 4 In the counties, all male and female residents aged 35-49 years were invited, and a 10% random sample of all residents aged 20-34. 5The screening programmes in the four areas included a questionnaire related to cardiovascular diseases. Height, weight, and blood pressure were measured according to an identical protocol. A non-fasting blood sample was dr...

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Objective: To determine the risk of dying from specified smoking-related diseases and from any cause in heavy smoking men and women (>15 cigarettes/day), who reduced their daily cigarette consumption by .50%. Design: A prospective cohort study. Setting: Three counties in Norway. Participants: 24 959 men and 26 251 women, aged 20-49 years, screened for risk factors of cardiova-?scular disease in the mid-1970s, screened again after 3-13 years, and followed up throughout 2003. Outcomes: Absolute mortality and relative risks adjusted for confounding variables, of dying from all causes, cardiovascular disease, ischaemic heart disease, all smoking-related cancer and lung cancer. Results: With sustained heavy smokers as reference, the smokers of both sexes who reduced their daily consumption (reducers) had the following adjusted relative risks (95% confidence interval (CI)): of dying from any cause, 1.02 (0.84 to 1.22); cardiovascular disease, 1.02 (0.75 to 1.39); ischaemic heart disease, 0.96 (0.65 to 1.41); smoking-related cancer, 0.86 (0.57 to 1.29); and lung cancer, 0.66 (0.36 to 1.21). The difference in cigarette consumption between two examinations was not a significant predictor of death from any of the causes. A follow-up from a third screening of the subgroup who were reducers at both second and third examinations (sustained reducers) did not have a lower risk than those who were heavy smokers at all three examinations. Conclusions: Long-term follow-up provides no evidence that heavy smokers who cut down their daily cigarette consumption by .50% reduce their risk of premature death significantly. In health education and patient counselling, it may give people false expectations to advise that reduction in consumption is associated with reduction in harm. D oes reduced daily cigarette consumption lead to lower mortality from the serious health consequences of cigarette smoking? In other words, does a reduction in consumption bring about reduction in harm?Numerous population studies have given ample evidence that quitting smoking entirely results in a marked reduction in the ill effects of smoking. Up to now, however, only one large prospective study has explored the long-term effects of unassisted reduced smoking. Godtfredsen et al [1][2][3][4] have pioneered in this field by following up a population of nearly 20 000 men and women living in Copenhagen, Denmark (the Copenhagen Centre for Prospective Population Studies). After mean observation periods ranging from 13.8 to 18 years, they published their results in a series of articles.The aim of this paper is to determine the risk in heavy smokers who reduced their cigarette consumption by at least 50%, named ''reducers'', compared with those who continued as heavy smokers. We report on a Norwegian population of 51 210 men and women, aged 20-49 years, who were examined in the mid1970s for cardiovascular disease risk factors and were examined again during the next 3-13 years at least once. These people were followed up throughout 2003 for deaths from serious smoki...

Objective-To study the association between number of cups of coffee consumed per day and coronary death when taking other major coronary risk factors into account.Design-Men and women attending screening and followed up for a mean of 6-4 years.Setting-Cardiovascular survey performed by ambulatory teams from the National Health Screening Service in Norway.Participants Results-At initial screening total serum cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, height, and weight were measured and self reported information about smoking history, physical activity, and coffee drinking habits was recorded. Altogether 168 men and 16 women died of coronary heart disease during follow up. Mean cholesterol concentrations for men and women were almost identical and increased from the lowest to highest coffee consumption group (13-1% and 10-9% respectively).With the proportional hazards model and adjustment for age, total serum and high density lipoprotein cholesterol concentrations, systolic blood pressure, and number of cigarettes per day the coefficient for coffee corresponded to a relative risk between nine or more cups of coffee and less than one cup of 2.2 (95% confidence interval 1-1 to 4.5) for men and 5-1 (0.4 to 60.3) for women. For men the relative risk varied among the three counties.Conclusions-Coffee may affect mortality from coronary heart disease over and above its effect in raising cholesterol concentrations. IntroductionThe cross-sectional association between coffee consumption and plasma or serum cholesterol concentrations has been studied extensively. A review article by Thelle et al covering 22 cross sectional studies and seven experiments in humans concluded that there is a direct relation between coffee consumption and total cholesterol concentration.' The strongest association of coffee and cholesterol was found in a study from Troms0 that reported a 10% increase in serum cholesterol concentration for men and an 8% increase for women when people not drinking coffee were compared with those drinking nine cups or more per day. For boiled coffee the association was even stronger: 12% in men and 10% in women.From prospective Norwegian data an increase of 10-20% has been found in deaths from coronary heart disease for each 0-5 mmol/l increase in cholesterol concentration when other risk factors have been adjusted for.3 La Croix et al found a 2 5-fold increase in

To study the association between smoking habits and the incidence of hip fracture, adjusted for leanness and physical inactivity, a cohort study with 3 years follow-up was conducted. Subjects were 34,856 adults aged 50 years or older who attended a health screening in Nord-Trøndelag County in Norway in 1984-1986 (91% of eligible subjects in 1986, n = 38,356). Of these, 421 suffered a hip fracture during the years 1986-1989. Using Cox regression models, the relative risk (with 95% confidence interval) of suffering a hip fracture for female smokers versus nonsmokers was 1.5 (1.0-2.4). These results refer to females when the female body mass index (BMI) was set at 25 kg/m2 in the female model (the mean BMI for the smoking female population in this study). Among thinner females, however, smoking had a much stronger effect. For instance, if the female BMI was set at 20 kg/m2, the relative risk was 3.0 (1.8-5.0). The relative risk of hip fracture for male smokers versus nonsmokers was 1.8 (1.2-2.9) irrespective of BMI. Smoking is associated with incidence of hip fracture in both sexes and also after adjusting for body mass index and physical inactivity (the effect of physical inactivity was adjusted for self-reported ill health because ill health was included in the model). For lean females, the association with current smoking was large, as large as if they added 10 years to their age.