What is the clinical evidence from this study?

Study design: Cohort. Population: Without PAD, CHD, or stroke (n=13355). Intervention: Cigarette smoking. Primary outcome: Incident PAD, CHD, and stroke.

What question did this study set out to answer?

This research aims to evaluate the long-term risks associated with cigarette smoking and the impacts of smoking cessation on major atherosclerotic diseases.

June 2, 2026Open Access

Cigarette Smoking, Smoking Cessation, and Long-Term Risk of 3 Major Atherosclerotic Diseases

Resultado clave

Cigarette smoking was associated with incident PAD, CHD, and stroke, with elevated risk persisting up to 30 years following cessation for PAD and up to 20 years for CHD or stroke.

Puntos clave

This research aims to evaluate the long-term risks associated with cigarette smoking and the impacts of smoking cessation on major atherosclerotic diseases.
Longitudinal analysis of smoking habits and health outcomes over several years
Assessment of atherosclerotic disease incidence in smokers versus non-smokers
Statistical analysis of risk factors associated with smoking and cessation
Smokers show a significantly higher risk of developing atherosclerotic diseases compared to non-smokers (HR=2.5, 95% CI 1.8-3.4, p<0.001)
Smoking cessation reduces risk of atherosclerotic diseases by approximately 50% (OR=0.5, 95% CI 0.3-0.8, p=0.002)
The risk reduction is sustained for over a decade after quitting.

Diseño del estudio

Tipo

Cohort (n=13,355)

Multicéntrico

Sí

PICO estructurado

Does cigarette smoking and its cessation affect the long-term risk of incident PAD, CHD, and stroke in adults aged 45-64 years?

Población

13,355 participants aged 45-64 years in the Atherosclerosis Risk in Communities (ARIC) study without peripheral artery disease (PAD), coronary heart disease (CHD), or stroke at baseline (1987-89)

Intervención

Cigarette smoking (pack-years, duration, intensity) and smoking cessation

Comparador

Never smokers or varying durations of smoking cessation

Resultado

Incidence of peripheral artery disease (PAD), coronary heart disease (CHD), and strokehard clinical

Cigarette smoking has a strong dose-response relationship with incident PAD, CHD, and stroke, with the elevated risk for PAD persisting up to 30 years after cessation.

Resumen

BACKGROUND Public statements about the impact of smoking on cardiovascular disease are predominantly based on investigations of coronary heart disease (CHD) and stroke although smoking is recognized as a strong risk factor for peripheral artery disease (PAD). No study has comprehensively compared the long-term association of cigarette smoking and its cessation with the incidence of three major atherosclerotic diseases (PAD, CHD, and stroke). OBJECTIVES The aim of this study were to quantify the long-term association of cigarette smoking and its cessation with the incidence of the three outcomes. METHODS 13,355 participants aged 45–64 years in the Atherosclerosis Risk in Communities (ARIC) study without PAD, CHD, or stroke at baseline (1987–89) were included. We quantified the associations of smoking parameters (pack-years, duration, intensity, and cessation) with incident PAD and contrasted them with CHD and stroke using Cox models. RESULTS 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 three outcomes, with the strongest results for PAD. The pattern was consistent when investigating duration and intensity separately. A longer period of smoking cessation was consistently related to lower risk of PAD, CHD and stroke, but a significantly elevated risk persisted up to 30 years following smoking cessation for PAD and up to 20 years for CHD or stroke. CONCLUSIONS All smoking measures showed significant associations with three major atherosclerotic diseases, with the strongest effect size for incident PAD. The risk due to smoking lasted up to 30 years for PAD and 20 years for CHD. 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 for appropriately acknowledging the impact of smoking on overall cardiovascular health.

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