Smoking cessation study supports ‘never too early, never too late’

Smoking cessation, whether early or late in life, showed significant associations with reducing three major atherosclerotic diseases, a study found.

To assess the association of smoking cessation with the incidence of coronary heart disease (CHD), stroke, and peripheral artery disease (PAD), researchers studied 13,355 participants ages 45 to 64 years from the Atherosclerosis Risk In Communities study. Smoking parameters (pack-years, duration, intensity, and cessation) were compared with incident PAD, CHD, and stroke. Results were published by the Journal of the American College of Cardiology on July 22.

Over a median follow-up of 26 years, there were 492 PAD cases, 1,798 CHD cases, and 1,106 stroke cases. A dose-response relationship was identified between pack-years of smoking and the three outcomes, with the strongest results for PAD. The pattern was consistent when duration and intensity of smoking were analyzed separately. A longer period of smoking cessation was consistently related to lower risk of CHD, stroke, and PAD. Smokers who had quit at least 30 years earlier had an 80% lower risk of PAD compared with current smokers. However, a significantly elevated risk persisted following smoking cessation for both CHD and PAD (up to 20 years and 30 years, respectively).

“Our results further highlight the importance of smoking prevention and early smoking cessation, and indicate the need for public statements to take PAD into account when acknowledging the impact of smoking on overall cardiovascular health,” the researchers noted.

An editorial addressed the implications for clinical practice and public health, stating, “Overall, [the study results] reinforce the existing public health message for smokers: it is never too early or too late to benefit from quitting. It is never too late because of the relatively rapid reversal of [cardiovascular disease] risk after smoking cessation and never too early because complete risk reversal requires decades—even longer for PAD than for myocardial infarction or stroke, as this report demonstrates.”