Life Course of Cardiovascular Disease by Smoking History -Multistate Life Table Analysis of the Framingham Heart Study Original Cohort

Abdullah A. Mamun, University of Groningen
Anna Peeters, Erasmus University
Jan Barendregt, Erasmus University
Wilma Nusselder, Erasmus University
Luc Bonnuex, Erasmus University

Background: Smokers combine an increased risk of disease with an increased risk of death. The duration of morbidity depends on that balance. This study compares the burden of cardiovascular disease in terms of lifetime risk and life years lived with disease between smokers and non-smokers. Methods: 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 Framingham Heart Study. Confidence intervals are derived using a non-parametric bootstrap procedure, based on 2,000 replicates. We report the bootstrap bias-correct, adjusted 95% confidence intervals. Results: The risk of developing any cardiovascular disease before age 70 is higher among smokers. Associated with their longer life expectancy, male non-smokers have higher lifetime risks of coronary heart disease, myocardial infarction, stroke and congestive heart failure. 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 but also 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. Non-smokers live 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. Conclusions: Not smoking will not eliminate cardiovascular disease, but it will postpone it to older ages. Smoking, by shortening life, decreases the years lived with cardiovascular disease throughout the life course. Paradoxically, in a non-smoking society, more people will live with cardiovascular disease but this will be concentrated at the end of life}.