Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men

Abstract

AimsThe risk of early and late death in relation to smoking and ex-smoking were studied. Methods and ResultsA cohort of 1711 Finnish men born between 1900 and 1919 were recruited in 1959 and followed up for 35 years. Information on smoking status was collected at each of six examinations made from 1959 to 1989 using a standardized questionnaire. Vital status at the end of 1994 was collected for every man. The effect of smoking on mortality was assessed using Cox proportional hazards model. Adjusted ratios for 35-year all-cause mortality were 1·62 (95% CI 1·40-1·88) in current smokers and 1·13 (CI 0·93-1·36) in former smokers compared with non-smokers. The hazards ratios for 35-year coronary heart disease mortality were 1·63 (CI 1·24-2·13) and 1·39 (CI 1·00-1·94), respectively. The risk for 10 year mortality was stronger than for 35 year mortality among both former and current smokers, given the same amount of cigarettes consumed. Men smoking persistently were most at risk, while those who persisted in quitting had no increased risk of death compared with non-smokers. ConclusionSmoking increases the risk of premature death in middle-aged men and giving up smoking earlier in life can prevent smoking attributable premature death.

Cost-effectiveness of pharmacogenetic testing to tailor smoking-cessation treatment

“…7 Effect of smoking on mortality Follow-up studies comparing smokers to non-smokers suggest that smoking roughly doubles the hazard of death from any cause. [55][56][57][58][59] We assumed, moreover, that in smokers who quit, the hazard ratio for death declines from its maximal value of 2 to the non-smoker's level (of 1) linearly over a 20-year period, 37 and that when a temporary quitter takes up smoking again, his relative hazard returns immediately to 2. In sensitivity analyses, we varied the maximal hazard ratio between 1.5 and 2.5.…”

The 2015 Canadian Hypertension Education Program (CHEP) guidelines for pharmacists

“…As a result of evidence linking smoking status to elevated BP and major cardiovascular events, [25][26][27][28][29][30] coupled with the evidence on the effectiveness and safety of smoking cessation interventions presented above, pharmacists are advised to regularly inquire about their hypertensive patients' smoking status and encourage quitting with both advice and pharmacotherapy. Evidence on the pharmacist's role in smoking cessation 31 and expanding scopes of practice in various provinces allowing for pharmacist prescribing of smoking cessation therapies and, in some cases, remuneration for smoking cessation advice further support the role pharmacists can play in global cardiovascular risk reduction.…”

Smoking: back to the future—again?

“…Whether ex-smokers should receive additional antiplatelet or antithrombotic therapy, such as aspirin, to address any additional risk factors over the first few years after quitting, is unknown. The study by Qaio et al [4] demonstrates that a 50-year-old man who quits smoking 20 cigarettes per day gains 12 min of life for every cigarette he does not smoke, or 3·1 years in total. There is thus no doubt that quitting is worthwhile.…”

“…In the study by Qaio et al in this issue [4] , 1711 Finnish men, who were aged 40-59 when enrolled into the Seven Countries Study in 1959, had their smoking history ascertained at baseline and reviewed 5 and 10 years later. When their vital status was determined after 35 years, 82% of the cohort had died.…”