• Ute Mons, Aysel Müezzinler, Carolin Gellert, Ben Schöttker, Christian C Abnet, Martin Bobak, Lisette de Groot, Neal D Freedman, Eugène Jansen, Frank Kee, Daan Kromhout, Kari Kuulasmaa, Tiina Laatikainen, Mark G O'Doherty, Bas Bueno-de-Mesquita, Philippos Orfanos, Annette Peters, Yvonne T van der Schouw, Tom Wilsgaard, Alicja Wolk, Antonia Trichopoulou, Paolo Boffetta, Hermann Brenner, and CHANCES Consortium.
• Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany u.mons@dkfz.de.
• BMJ. 2015 Jan 1;350:h1551.

ObjectiveTo investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures.DesignIndividual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis.ResultsOverall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar.ConclusionsOur study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.© Mons et al 2015.

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