Smoking status and life expectancy after acute myocardial infarction in the elderly
Department of Quantitative Health Sciences
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Geriatrics
OBJECTIVE: Smokers have lower short-term mortality after acute myocardial infarction (AMI) than non-smokers; however, little is known about the long-term effects of smoking on life expectancy after AMI. This study aimed to quantify the burden of smoking after AMI using life expectancy and years of life lost.
METHODS: We analysed data from the Cooperative Cardiovascular Project, a medical record study of 158 349 elderly Medicare patients with AMI and over 17 years of follow-up, to evaluate the age-specific association of smoking with life expectancy and years of life lost after AMI.
RESULTS: Our sample included 23 447 (14.8%) current smokers. Current smokers had lower crude mortality up to 5 years, which was largely explained by their younger age at AMI. After adjustment other patient characteristics, smoking was associated with lower 30-day (HR 0.91, 95% CI 0.87 to 0.94) but higher long-term mortality (17-year HR 1.19, 95% CI 1.17 to 1.20) after AMI. Overall, crude life expectancy estimates were lower for current smokers than non-smokers at all ages, which translated into sizeable numbers of life-years lost attributable to smoking. As age at AMI increased, the magnitude of life-years lost due to smoking decreased. After full risk adjustment, the differences in life expectancy between current smokers and non-smokers persisted at all ages.
CONCLUSIONS: Current smoking is associated with lower life expectancy and large numbers of life-years lost after AMI. Our findings lend additional support to smoking cessation efforts after AMI.
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Citation: Heart. 2016 Jan 15;102(2):133-9. doi: 10.1136/heartjnl-2015-308263. Epub 2015 Nov 23. Link to article on publisher's site
Bucholz, Emily M.; Beckman, Adam L.; Kiefe, Catarina I.; and Krumholz, Harlan M., "Smoking status and life expectancy after acute myocardial infarction in the elderly" (2016). University of Massachusetts Medical School Faculty Publications. 853.