Association between smoking and cardiovascular disease in a Caribbean country

Abstract Background Smoking is an established modifiable risk factor for cardiovascular disease (CVD), the leading cause of morbidity and mortality globally. Given the decline in the prevalence of smoking in the Caribbean region, and a reported lack of association with CVD, studies within the local context are essential to assess the contribution of smoking to CVD burden, identify high-risk groups and inform targeted prevention strategies. Purpose This study examined the prevalence of smoking and its association with CVD in Trinidad and Tobago. Method Baseline data from Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study were analysed. Smoking status was self-reported and categorised as current, former or non-smoker, while CVD status was based on self-reported prior medical diagnosis of coronary heart disease, angina, myocardial infarction, heart failure or stroke. Pearson’s chi-squared test was used to evaluate differences in CVD prevalence across smoking categories. Multivariable logistic regression models, were used to estimate the odds ratio (ORs) and 95% confidence intervals (CIs) for associations between smoking and CVD, adjusting for age, sex, and socioeconomic (education, income and marital status), psychological (stress, depression and anxiety) and lifestyle (diet, physical activity and alcohol use) factors. Results The analysis included 829 participants, 61.5% were females and 38.5% males. Smoking prevalence differed by sex: 44.0% of males were non-smokers, 39.4% former smokers and 16.6% current smokers, compared with 80.5%, 13.1% and 6.4% of females, respectively. The overall prevalence of CVD was 9.6%, with rates of 8.8% among non-smokers, 11.8% among former smokers and 10.0% among current smokers. There was no statistically significant difference in CVD prevalence across smoking categories (p = 0.49). Multivariable model results showed no overall statistically significant association between smoking and CVD, or when stratified by sex. However, age and moderate physical activity were found to be significant. Conclusion In this cohort, the prevalence of smoking was higher in males than females, which reflected the situation locally. Findings failed to show a statistically significant association between smoking and CVD. While smoking is a modifiable risk factor for CVD, particularly in older males, future studies should explore its predictive value in Trinidad and Tobago, and CVD risk assessment locally should consider additional context-specific factors, such as socioeconomic, environmental and lifestyle factors, which may now be gaining greater relative importance.