March 1, 2004European Heart Journal105 citationsOpen Access
View Full PaperSmoking decreases the duration of life lived with and without cardiovascular disease: a life course analysis of the Framingham Heart Study
Key Result
Non-smokers lived 8.66 years (men) and 7.59 years (women) longer than smokers, and had more years free of cardiovascular disease, but ultimately spent more years living with the disease.
Study Design
Type
Cohort (n=4,723)
Structured PICO
Does smoking alter the lifetime risk and duration of life lived with and without cardiovascular disease compared to non-smoking?
P
Population
4,723 smokers and non-smokers from the Original Framingham Heart Study followed over 20 biannual observations to compare lifetime cardiovascular disease burden.
E
Exposure
Smoking
C
Comparator
Non-smoking
O
Outcome
Burden of cardiovascular disease in terms of lifetime risk and life years lived with diseasehard clinical
While non-smokers live longer and have more years free of cardiovascular disease, their increased longevity paradoxically results in more total years lived with cardiovascular disease over the life course compared to smokers.
Main Result
Mean Difference: 8.66 (95% CI 7.61–9.63)
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.