Evidence map›Paper›PMID 25896935›Full record

SynthesisBMJ (Clinical research ed.)2015

Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium.

Ute Mons, Aysel Müezzinler, Carolin Gellert, Ben Schöttker, Christian C Abnet, Martin Bobak, Lisette de Groot, Neal D Freedman, Eugène Jansen, Frank Kee and 14 more

Open access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 221 papers, 22 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
221citing papers in PubMed, 22 pooled it
25.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

221 citing papers in PubMed, 22 syntheses or guidelines pooled it, 534 citations in OpenAlex.

  1. Guideline
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  7. Smoking cessation for secondary prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2022
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  12. Guideline
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  15. Guideline
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  17. Telephone counselling for smoking cessation.The Cochrane database of systematic reviews · 2019
    Pooled it
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  19. Guideline
  20. Guideline

161 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors at 14 institutions in 9 countries.

Ute MonsDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany u.mons@dkfz.de.
Aysel MüezzinlerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany.
Carolin GellertDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Ben SchöttkerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Christian C AbnetNational Cancer Institute, Bethesda, MD, USA.
Martin BobakDepartment of Epidemiology and Public Health, University College London, London, UK.
Lisette de GrootDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands.
Neal D FreedmanNational Cancer Institute, Bethesda, MD, USA.
Eugène JansenCentre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
Frank KeeUKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
Daan KromhoutDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands.
Kari KuulasmaaNational Institute for Health and Welfare (THL), Helsinki, Finland.
Tiina LaatikainenNational Institute for Health and Welfare (THL), Helsinki, Finland Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Hospital District of North Karelia, Joensuu, Finland.
Mark G O'DohertyUKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
Bas Bueno-de-MesquitaDepartment for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Philippos OrfanosHellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
Annette PetersInstitute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany German Center for Cardiovascular Disease Research (DZHK eV), partner-site Munich, Munich, Germany.
Yvonne T van der SchouwDepartment of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Tom WilsgaardDepartment of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Alicja WolkInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Antonia TrichopoulouHellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
Paolo BoffettaHellenic Health Foundation, Athens, Greece Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Hermann BrennerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
CHANCES Consortium
Heidelberg University · DEHellenic Health Foundation · GRGerman Cancer Research Center · DENational Cancer Institute · USNational Institute for Public Health and the Environment · NLQueen's University Belfast · GBWageningen University & Research · NLFinnish Institute for Health and Welfare · FIGerman Centre for Cardiovascular Research · DEKarolinska Institutet · SENorth Karelia Central Hospital · FIUiT The Arctic University of Norway · NOUniversity College London · GBUniversity Medical Center Utrecht · NL

Funding

HRS Yrs29-34: Y33 SSA CoFundingU01AG009740 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Jessica Faul, KENNETH M LANGA · 1990 to 2026
$555.8M
Understanding and Improving Healthcare Decision-Making and Outcomes for People Living with Alzheimer's Disease and Related DementiasP01AG005842 · NIA · NATIONAL BUREAU OF ECONOMIC RESEARCH · PI JOSEPH J DOYLE · 1986 to 2026
$56.5M
WEALTH DISPARITIES AMONG MATURE AND OLDER ADULTSP01AG008291 · NIA · RAND CORPORATION · PI HURD, MICHAEL D · 1989 to 2018
$19.4M
RAND CENTER FOR THE STUDY OF AGINGP30AG012815 · NIA · RAND CORPORATION · PI HURD, MICHAEL D · 1999 to 2020
$13.7M
Health disparities and agingin societies in transitionR01AG023522 · NIA · UNIVERSITY COLLEGE LONDON · PI MARMOT, MICHAEL G · 2004 to 2008
$2.2M
DEVELOPING AN ISRAELI VERSION OF THE HRS/SHARE PROJECTR21AG025169 · NIA · HEBREW UNIVERSITY OF JERUSALEM · PI LITWIN, HOWARD · 2004 to 2006
$297k
Intramural NIH HHSMedical Research Council G0601463NIA NIH HHS P01 AG005842NIA NIH HHS P01 AG08291NIA NIH HHS P30 AG12815NIA NIH HHS R01 AG23522-01NIA NIH HHS R21 AG025169NIA NIH HHS U01 AG09740-13S2NIA NIH HHS Y1-AG-4553-01Wellcome Trust 064947Wellcome Trust 081081
6 · The paper itself

Abstract

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.

Indexed as

Smoking CessationAgedAge FactorsCardiovascular DiseasesEuropeFemaleHealth Knowledge, Attitudes, PracticeHumansIncidenceMaleMiddle AgedNorth AmericaProportional Hazards ModelsProspective StudiesRisk FactorsSmoking

Identifiers

PMID25896935
PMCPMC4413837
OpenAlexW2132279603

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.