Combined effect of obesity and smoking on cardiovascular and all-cause mortality. Data from a long-term 34-year prospective cohort study

Aim. To assess the cardiovascular and all-cause mortality in obese smokers and obese former smokers, according to the results of a 34-year prospective cohort study. Material and methods. The study included 630 men and 916 women aged 20-59 years who underwent primary screening in 1988-1991. Obesity was defined as a body mass index ≥30,0 kg/m 2 . Smokers were defined as those who smoked ≥1 cigarette per day or who had quit smoking less than a year ago. Smoking cessation included those who quit smoking or had not smoked for more than one year. Over 34 years of follow-up, there were 556 deaths, 244 of which were from cardiovascular causes. Results. Obesity and smoking are independent predictors of premature death. The combination of obesity and smoking significantly increases the risk of all-cause (hazard ratio (HR) 4,45; p<0,001) and cardiovascular death (HR 5,1; p<0,001). Obesity in non-smokers increases the risk of all-cause (HR 2,8; p<0,001) and cardiovascular death (HR 3,2; p<0,001). Smoking in non-obese individuals also increases the risk of all-cause (HR 3,2; p<0,001) and cardiovascular death (HR 2,6; p<0,001). The combination of obesity and smoking cessation increases the risk of all-cause (HR 3,8; p<0,001) and cardiovascular death (HR 4,3; p<0,001). The combination of obesity and smoking in young age is particularly dangerous, as it significantly increases the risk of all-cause (HR 7,2; p<0,001) and cardiovascular death (HR 13,7; p<0,001). Obesity as a predictor of death manifests itself significantly later compared to smoking. The lowest 34-year survival rate was found in obese smokers — 34,3%. Survival among non-smokers and non-obese individuals was 78,8%, while among non-obese smokers — 49,1%, and non-smokers with obesity — 46,2%. Conclusion. Obesity, tobacco smoking, and previous smoking are independent and influential modifiable risk factors for premature death, and their combination significantly increases cardiovascular and all-cause mortality. all mortality rates.