Smoking outcomes significantly improve risk prediction for atherosclerotic CVD
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A retrospective analysis published in JAMA Cardiology found significant improvement in atherosclerotic CVD risk prediction among participants with former smoking, pack-years and years since quitting.
“Because ASCVD risk increases with greater pack-years smoked and decreases with sustained cessation, ASCVD risk may be misestimated in individuals who have ever smoked heavily,” Meredith S. Duncan, PhD, assistant professor in the department of biostatistics at the University of Kentucky and instructor in the division of cardiovascular medicine at Vanderbilt University Medical Center, and colleagues wrote.
The retrospective analysis used data from the Framingham Heart Study, a community-based cohort study, and used risk factor definitions from the 2013 Pooled Cohort Equation models, including age, total cholesterol, HDL, systolic BP, antihypertensive use, current smoking status and diabetes. The analysis included 3,908 participants (mean age, 55 years; 51.5% women) who attended their first examination from 1971 to 1975 and were followed until December 2016.
The primary outcome was incident ASCVD, including MI, fatal/nonfatal ischemic stroke, CHD or death.
Researchers observed 358 incident ASCVD events that occurred in men and 197 events that occurred in women. There was high ever-smoking prevalence and high median pack-years among men (77% and 39 years, respectively) and women (78% and 32 years, respectively).
The researchers built four sex-specific ASCVD risk prediction models adjusted for former smoking, pack-years and years since quitting. These models were compared through C-statistic change, continuous net reclassification improvement and relative integrated discrimination improvement.
Among both men and women, there were significant but modest continuous net reclassification improvements (men, 0.23; women, 0.34) and relative integrated discrimination improvement (men, 0.19; women, 0.11) values when adjusting for former smoking, pack-years and years since quitting compared with the Pooled Cohort Equations with continuous predictors.
“The number of former smokers is growing, and such individuals remain at excess ASCVD risk compared with never smokers for up to 16 years after quitting,” the researchers wrote. “If validated in individuals of other races and ethnicities and socioeconomic groups, modification of the Pooled Cohort Equations to include these variables could mitigate underestimation of risk among current and former smokers.”
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