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European Heart Journal 2004 25(5):409-415; doi:10.1016/j.ehj.2003.12.015
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Smoking decreases the duration of life lived with and without cardiovascular disease: a life course analysis of the Framingham Heart Study

Abdullah Al Mamuna,*, Anna Peetersb, Jan Barendregtb, Frans Willekensa, Wilma Nusselderb and Luc Bonneuxb for NEDCOM, The Netherlands Epidermiology and Demography Compression of Morbidity Research Group

a University of Groningen, Groningen, The Netherlands
b Erasmus MC Rotterdam, Rotterdam, The Netherlands

* Corresponding author. Present address: Division of International Health, School of Population Health, University of Queensland, Level 4, Public Health Building, Mayne Medical School, Hertson Road, Brisbane 4006, Australia. Tel.: +61-7-33-464689; fax: +61-73-36-55599
E-mail address: mamun{at}sph.uq.edu.au

Received 3 June 2003; revised 1 December 2003; accepted 4 December 2003

Abstract

Aims To compare the burden of cardiovascular disease in terms of lifetime risk and life years lived with disease between smokers and non-smokers.

Methods and results We constructed multi-state life tables describing transitions through various cardiovascular diseases for 4723 smokers and non-smokers observed during 20 biannual observations in the Original Framingham Heart Study. Non-smokers live 8.66 (95% CI 7.61–9.63) (men) and 7.59 (95% CI 6.33–8.92) (women) years longer than smokers and more years free of cardiovascular disease: 6.22 (95% CI 5.09–7.30) years for males and 4.93 (95% CI 3.54–6.29) for females. But non-smokers spend more years with cardiovascular disease over the life course: 2.43 (95% CI 1.72–3.16) years for males and 2.66 (95% CI 1.87–3.38) years for females. The risk of cardiovascular disease before age 70 is higher among smokers, but over the entire lifecourse male non-smokers have higher risks of coronary heart disease, myocardial infarction, stroke and congestive heart failure, and female non-smokers have higher risks of coronary heart disease and congestive heart failure.

Conclusion Smoking, by shortening life, decreases both the probability and duration of cardiovascular disease throughout the life course. Non-smokers live many years longer and longer free of cardiovascular disease than smokers, but at the end of their life non-smokers will have lived longer with cardiovascular disease.

Key Words: Smoking • Lifestyle • Mortality • Cardiovascular disease


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