Differential impact of smoking on cardiac or non-cardiac death according to age

Choi, Wonsuk; Kim, Sun-Hwa; Kang, Si Hyuck; Park, Jin Joo; Yoon, Chang Hwan; Youn, Tae‐Jin

doi:10.1371/journal.pone.0224486

Cited by 5 publications

(3 citation statements)

References 27 publications

(42 reference statements)

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“…For this reason, our study further extends knowledge in the field by strictly defining the SMuRF based on medical records and laboratory values during hospitalization. Moreover, only never smokers were included as nonsmokers, as compared to previous analyses where ex-smokers were considered nonsmokers due to the persistent negative impact of smoking on cardiovascular mortalities even after cessation ( 7 – 9 , 44 – 46 ). Interestingly, although the proportions of SMuRF-less were 25% ( 8 ), 19% ( 7 ), and 15% ( 9 ) for STEMI patients in the previous studies, our study revealed <6% for STEMI and NSTEMI patients without SMuRF, which may, in part, be explained by the detection of SMuRF in our study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors

Sia

Zheng

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAcute myocardial infarction (AMI) cases have decreased in part due to the advent of targeted therapies for standard modifiable cardiovascular disease risk factors (SMuRF). Recent studies have reported that ST-elevation myocardial infarction (STEMI) patients without SMuRF (termed “SMuRF-less”) may be increasing in prevalence and have worse outcomes than “SMuRF-positive” patients. As these studies have been limited to STEMI and comprised mainly Caucasian cohorts, we investigated the changes in the prevalence and mortality of both SMuRF-less STEMI and non-STEMI (NSTEMI) patients in a multiethnic Asian population.MethodsWe evaluated 23,922 STEMI and 62,631 NSTEMI patients from a national multiethnic registry. Short-term cardiovascular and all-cause mortalities in SMuRF-less patients were compared to SMuRF-positive patients.ResultsThe proportions of SMuRF-less STEMI but not of NSTEMI have increased over the years. In hospitals, all-cause and cardiovascular mortality and 1-year cardiovascular mortality were significantly higher in SMuRF-less STEMI after adjustment for age, creatinine, and hemoglobin. However, this difference did not remain after adjusting for anterior infarction, cardiopulmonary resuscitation (CPR), and Killip class. There were no differences in mortality in SMuRF-less NSTEMI. In contrast to Chinese and Malay patients, SMuRF-less patients of South Asian descent had a two-fold higher risk of in-hospital all-cause mortality even after adjusting for features of increased disease severity.ConclusionSMuRF-less patients had an increased risk of mortality with STEMI, suggesting that there may be unidentified nonstandard risk factors predisposing SMuRF-less patients to a worse prognosis. This group of patients may benefit from more intensive secondary prevention strategies to improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors

Sia

Zheng

et al. 2022

Front. Cardiovasc. Med.

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“…Study patients were categorized by smoking status and changes before and after AF diagnosis ( Figure 1 ). Smoking status was evaluated using a self-reported questionnaire in the first and second health examinations [ 19 , 20 , 21 , 22 , 23 , 24 ]. In this self-reported questionnaire, subjects chose one answer among “never smokers,” “ex-smokers”, and “current smokers” and recorded the cumulative amount of their smoking as packs per year.…”

Section: Methodsmentioning

confidence: 99%

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death

Lee

Choi

Jung

et al. 2021

JCM

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Limited data are available regarding the impact of smoking cessation after atrial fibrillation (AF) diagnosis on clinical outcomes. Using the Korean National Health Insurance Service database, we included patients newly diagnosed with AF and categorized them into four groups as follows: (i) never smokers, (ii) ex-smokers, (iii) smoking cessation after AF diagnosis (“quitters”), and (iv) current smokers. The primary outcomes were incident ischemic stroke and all-cause death during follow-up. Fatal ischemic stroke and death from cerebrovascular events were evaluated as secondary outcomes. Among 97,637 patients (mean age, 61 years; mean CHA2DS2-VASc score, 2.3), 6.9% stopped smoking after AF diagnosis. The mean follow-up duration was 3.2 ± 2.0 years. After multivariable adjustment, quitters had lower risks of ischemic stroke (hazard ratio (HR), 0.702; 95% confidence interval (CI), 0.595–0.827) and all-cause death (HR, 0.842; 95% CI, 0.748–0.948) than current smokers. Quitters after AF diagnosis were associated with lower risks of fatal ischemic stroke (HR, 0.454; 95% CI, 0.287–0.718) and death from cerebrovascular events (HR, 0.664; 95% CI, 0.465–0.949) compared with current smokers. Quitting smoking may reduce the risk of ischemic stroke, the severity of ischemic stroke, and the incidence of cerebrovascular events in patients with new-onset AF.

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“…[27,28] Nonetheless, our observation on the stronger association of cigarette smoking with non-cardiovascular than cardiovascular mortality is in keeping with the results of previous studies in the elderly. [29][30][31] There is indeed a strong association between cigarette smoking and non-cardiovascular disease such as cancers and chronic respiratory diseases. [32] In China, 27.8%, 18.2% and 19.6% of the deaths that are attributable to smoking are cancers, respiratory diseases and cardiovascular diseases.…”

Section: Discussionmentioning

confidence: 99%

Current and recent cigarette smoking in relation to cardiovascular and non-cardiovascular mortality in an elderly male Chinese population

WANG,

YE,

MIAO

et al. 2023

Journal of Geriatric Cardiology

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OBJECTIVETo investigate the association between current and former smoking and the risk of mortality in elderly Chinese men.METHODS Our study participants were elderly (≥ 60 years) men recruited in a suburban town of Shanghai. Cigarette smoking status was categorized as never smoking, remote (cessation > 5 years) and recent former smoking (cessation ≤ 5 years), and light-tomoderate (≤ 20 cigarettes/day) and heavy current smoking (> 20 cigarettes/day). Cox proportional hazards models and restricted cubic splines were used to examine the associations of interest. RESULTSThe 1568 participants had a mean age of 68.6 ± 7.1 years. Of all participants, 311 were never smokers, 201 were remote former smokers, 133 were recent former smokers, 783 were light-to-moderate current smokers and 140 were heavy current smokers. During a median follow-up of 7.9 years, all-cause, cardiovascular and non-cardiovascular deaths occurred in 267, 106 and 161 participants, respectively. Heavy current smokers had the highest risk of all-cause and non-cardiovascular mortality, with an adjusted hazard ratio (HR) of 2.30 (95% CI: 1.34-4.07) and 3.98 (95% CI: 2.03-7.83) versus never smokers, respectively. Recent former smokers also had a higher risk of all-cause (HR = 1.62, 95% CI: 1.04-2.52) and non-cardiovascular mortality (HR = 2.40, 95% CI: 1.32-4.37) than never smokers. Cox regression restricted cubic spline models showed the highest risk of all-cause and non-cardiovascular mortality within 5 years of smoking cessation and decline thereafter. Further subgroup analyses showed interaction between smoking status and pulse rate (≥ 70 beats/min vs. < 70 beats/min) in relation to the risk of all-cause and non-cardiovascular mortality, with a higher risk in current versus never smokers in those participants with a pulse rate below 70 beats/min. CONCLUSIONS Cigarette smoking in elderly Chinese confers significant risks of mortality, especially when recent former smoking is considered together with current smoking.

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Differential impact of smoking on cardiac or non-cardiac death according to age

Cited by 5 publications

References 27 publications

Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors

Comparison of Mortality Outcomes in Acute Myocardial Infarction Patients With or Without Standard Modifiable Cardiovascular Risk Factors

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death

Current and recent cigarette smoking in relation to cardiovascular and non-cardiovascular mortality in an elderly male Chinese population

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