Inclusion of Smoking Data in Cardiovascular Disease Risk Estimation

Abstract

IMPORTANCE Former heavy smokers (ie, those with Ն20 pack-years of smoking) may have higher atherosclerotic cardiovascular disease (ASCVD) risk than never smokers for up to 16 years after smoking cessation. However, the 2013 pooled cohort equations (PCE) do not account for pack-years of smoking and only consider current vs noncurrent smoking status without distinguishing former smokers from never smokers. OBJECTIVE To assess the predictive utility of smoking history when added to the PCE using data from 18 400 person examinations among Framingham offspring participants.DESIGN, SETTING, AND PARTICIPANTS This is a retrospective analysis of prospectively collected data from the Framingham Heart Study, a community-based cohort. Framingham Heart Study offspring cohort participants attending their first examination (1971)(1972)(1973)(1974)(1975) who were followed-up through December 2016 were included.EXPOSURES Self-reported current/former/never smoking status, pack-years smoked, and years since quitting. MAIN OUTCOMES AND MEASURESIncident ASCVD (myocardial infarction, fatal/nonfatal ischemic stroke, coronary heart disease death). RESULTSOf 3908 patients, there were 358 and 197 events among 1895 men and 2013 women, respectively, with a mean (SD) age of 55 (9.5) years. Ever smoking prevalence was high (6474 men [77%] and 7760 women [78%]), as were median pack-years (men: 39; women: 32 overall person examinations). Four sex-specific ASCVD risk prediction models were built using pooled-repeated Cox proportional hazards regression. The PCEs were was fit in this sample with continuous predictors on their natural scale (ie, not logarithmically transformed) as well as polynomials accounting for nonlinearity and then cumulatively adjusted for former smoking, pack-years, and years since quitting. Models were compared via change in C statistic, continuous net reclassification improvement (NRI[>0]), and relative integrated discrimination improvement (rIDI). Including former smoking status, pack-years, and years since quitting had significant but modest NRI(>0) and rIDI values compared with the PCE with continuous variables on their natural scale in both sexes (men: NRI[>0] = 0.23; rIDI = 0.19; women: NRI[>0] = 0.34, rIDI = 0.11; change in C statistic = 0.01 for both).CONCLUSIONS AND RELEVANCE Former smoking, pack-years, and years since quitting significantly improved ASCVD risk prediction in this sample. The Framingham Heart Study offspring cohort is largely composed of non-Hispanic White participants of European ancestry. If results are validated in cohorts of race and ethnicity groups other than White, these variables could be considered for inclusion in future ASCVD risk prediction models.

Chronic Electronic Cigarette Use and Atherosclerosis Risk in Young People: A Cross-Sectional Study—Brief Report

“…To our knowledge, this is among the first studies in humans to confirm early alterations in proatherogenic properties of blood monocytes and plasma collected from otherwise healthy young people who smoke TCIGs compared with people who do not use tobacco products. Our findings in TCIG smokers compared with nonsmokers controls are consistent with the notion that this atherogenesis assay is a strong mechanistic tool to predict future cardiovascular risk in humans given the established link of TCIGs with future cardiovascular disease, 9 and provides a rationale for its use in assessing proatherogenic changes in young people who use ECIGs. Similar yet significantly less severe alterations in proatherogenic properties were detected in blood monocytes and plasma collected in otherwise healthy young people who use ECIGs compared with people who do not use tobacco products.…”

“…Rather, consistency, direction, and magnitude of the effect in conjunction with the nominal P values were considered to help distinguish true and false-positive findings. 9…”

Establishment and verification of a nomogram that predicts the risk for coronary slow flow

“…Cardiovascular diseases are more prevalent in male patients, but women develop these diseases about a decade later than men. This phenomenon may be related to the effect of estrogen on improving vascular endothelial function and reducing LDL-C ( 21 , 22 ). However, most men have histories of smoking and drinking.…”

Association between Cardiovascular Disease Risk and long COVID-19: A Systematic Review and Meta-analysis

“…All included studies, even those with a high rating, inherently entail an unavoidable risk of bias, owing to their observational characteristic 31 . And we also hope to collect the data of long Covid patients' BMI 37 , smoking status [38][39][40] , diabetes 41 , high cholesterol 42,43 , vaccination [44][45][46] etc as much as possible, further identifying sources of heterogeneity. But in our study, all the HRs, RRs and ORs are all over >1.0, as well as the absence of publication bias But, the preeminent strategy for averting severe complications stemming from SARS-CoV-2 infection is still vaccination 48,49 .…”

“…The heterogeneity was relatively high, but with the help of Meta-regression, we figured out that country, study design, total number of samples, age at baseline and total months of follow-up should be responsible for sources of heterogeneity to a certain extent Supplementary material online, Appendix Figure. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Meanwhile, owing to the observational research's character, all studies inherently entail an inevitable risk of bias, irrespective of their quality rating 31…”