Health consequences of reduced daily cigarette consumption

Abstract

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...

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