Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium.

INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years. METHODS: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014. RESULTS: A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively. CONCLUSIONS: Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.

Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania.

AIMS: This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. METHODS: Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45-64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. RESULTS: Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006-2008 than in 1983-1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5-6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15-0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12-0.97) but not in women (HR 0.38, 95% CI 0.09-1.67). CONCLUSIONS: An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

[Trends in morbidity from acute myocardial infarction, risk factors and risk of ischemia]. / Sergamumas uminiu miokardo infarktu, rizikos veiksniai ir isemijos rizika.

THE AIM: To assess the linkages of trends between the mean values of main risk factors of ischemic heart disease, the overall high risk of coronary within 10 years and morbidity from acute myocardial infarction in Kaunas population aged 35-64 years during the period from 1983 to 2002. MATERIAL AND METHODS: Data sources were four cross-sectional surveys (1983-1984, 1986-1987, 1992-1993, 2001-2002) and population-based ischemic heart disease register (1983-2001) of Kaunas population aged 35-64 years. Data collection was conducted according to the method using in the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project. The overall high risk developing a fatal or non-fatal myocardial infarction or sudden death within 10 years was calculated by PROCAM Risk Score. RESULTS: During 1983-2002 the mean value of systolic blood pressure decreased among men and women (respectively, from 138.8 to 136.4 mmHg, p<0.05 and from 139.7 to 133.2 mmHg, p<0.05). Body mass index decreased among men (from 27.5 to 27.4 kg/m2, p<0.05), and diastolic blood pressure decreased among women (from 86.5 to 82.7 mmHg, p<0.05). In 1983-2002 the overall high 10-year risk also decreased in men and women (respectively, from 20.4 % to 16.3% and from 7.9% to 5.4%). During 1992-2001 the trend of morbidity from acute myocardial infarction was declining among men (by - 4.6 %/year, p<0.01) and among women (by--1.3 %/year, p>0.05). CONCLUSION: Trends of the overall high 10-year coronary risk and morbidity from acute myocardial infarction were analogous in both genders.