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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Jun;57(6):412–416. doi: 10.1136/jech.57.6.412

Smoking reduction, smoking cessation, and incidence of fatal and non-fatal myocardial infarction in Denmark 1976–1998: a pooled cohort study

N Godtfredsen 1, M Osler 1, J Vestbo 1, I Andersen 1, E Prescott 1
PMCID: PMC1732492  PMID: 12775785

Abstract

Design: Prospective cohort study with record linkage to mortality and hospital registers. The association of individual change in smoking with myocardial infarction was examined in Cox proportional hazard analyses with continuous heavy smokers (⩾5 cigarettes/day) as reference.

Setting: Pooled data from three population studies conducted in Copenhagen, Denmark.

Participants: 10 956 men and 8467 women with complete information on smoking habits at two examinations five to ten years apart were followed up from the second examination for a first hospital admission or death from myocardial infarction. Mean duration of follow up was 13.8 years.

Main results: A total of 643 participants who were heavy smokers at baseline reduced their daily tobacco consumption by at least 50% without quitting between first and second examination, and 1379 participants stopped smoking. During follow up 1658 men and 521 women experienced a fatal or non-fatal myocardial infarction. After adjustment for cardiovascular risk factors, people who stopped smoking had a decreased risk of myocardial infarction, hazard ratio 0.71 (95% confidence intervals 0.59 to 0.85). Smoking reduction was not associated with reduced risk of myocardial infarction, hazard ratio 1.15 (95% confidence intervals 0.94 to 1.40). These associations remained unchanged after controlling for baseline illness in different ways.

Conclusions: Smoking cessation in healthy people reduces the risk of a subsequent myocardial infarction, whereas this study provides no evidence of benefit from reduction in the amount smoked.

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Selected References

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  1. Benowitz N. L., Jacob P., 3rd, Kozlowski L. T., Yu L. Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide. N Engl J Med. 1986 Nov 20;315(21):1310–1313. doi: 10.1056/NEJM198611203152102. [DOI] [PubMed] [Google Scholar]
  2. Blanco-Cedres Lucila, Daviglus Martha L., Garside Daniel B., Liu Kiang, Pirzada Amber, Stamler Jeremiah, Greenland Philip. Relation of cigarette smoking to 25-year mortality in middle-aged men with low baseline serum cholesterol: the Chicago Heart Association Detection Project in Industry. Am J Epidemiol. 2002 Feb 15;155(4):354–360. doi: 10.1093/aje/155.4.354. [DOI] [PubMed] [Google Scholar]
  3. Bolliger C. T., Zellweger J. P., Danielsson T., van Biljon X., Robidou A., Westin A., Perruchoud A. P., Säwe U. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ. 2000 Aug 5;321(7257):329–333. doi: 10.1136/bmj.321.7257.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cullen P., Schulte H., Assmann G. Smoking, lipoproteins and coronary heart disease risk. Data from the Münster Heart Study (PROCAM). Eur Heart J. 1998 Nov;19(11):1632–1641. doi: 10.1053/euhj.1998.1086. [DOI] [PubMed] [Google Scholar]
  5. Dornelas E. A., Sampson R. A., Gray J. F., Waters D., Thompson P. D. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Prev Med. 2000 Apr;30(4):261–268. doi: 10.1006/pmed.2000.0644. [DOI] [PubMed] [Google Scholar]
  6. Eliasson B., Hjalmarson A., Kruse E., Landfeldt B., Westin A Effect of smoking reduction and cessation on cardiovascular risk factors. Nicotine Tob Res. 2001 Aug;3(3):249–255. doi: 10.1080/14622200110050510. [DOI] [PubMed] [Google Scholar]
  7. Fagerström K. O., Tejding R., Westin A., Lunell E. Aiding reduction of smoking with nicotine replacement medications: hope for the recalcitrant smoker? Tob Control. 1997 Winter;6(4):311–316. doi: 10.1136/tc.6.4.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hagerup L., Eriksen M., Schroll M., Hollnagel H., Agner E., Larsen S. The Glostrup population studies. Collection of epidemiologic tables. Reference values for use in cardiovascular population studies. Scand J Soc Med Suppl. 1981;20:1–112. [PubMed] [Google Scholar]
  9. Hein H. O., Suadicani P., Gyntelberg F. Alcohol consumption, serum low density lipoprotein cholesterol concentration, and risk of ischaemic heart disease: six year follow up in the Copenhagen male study. BMJ. 1996 Mar 23;312(7033):736–741. doi: 10.1136/bmj.312.7033.736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hughes J. R., Cummings K. M., Hyland A. Ability of smokers to reduce their smoking and its association with future smoking cessation. Addiction. 1999 Jan;94(1):109–114. doi: 10.1046/j.1360-0443.1999.9411097.x. [DOI] [PubMed] [Google Scholar]
  11. Hurt R. D., Croghan G. A., Wolter T. D., Croghan I. T., Offord K. P., Williams G. M., Djordjevic M. V., Richie J. P., Jr, Jeffrey A. M. Does smoking reduction result in reduction of biomarkers associated with harm? A pilot study using a nicotine inhaler. Nicotine Tob Res. 2000 Nov;2(4):327–336. doi: 10.1080/713688154. [DOI] [PubMed] [Google Scholar]
  12. Keil U., Liese A. D., Hense H. W., Filipiak B., Döring A., Stieber J., Löwel H. Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases. Eur Heart J. 1998 Aug;19(8):1197–1207. doi: 10.1053/euhj.1998.1089. [DOI] [PubMed] [Google Scholar]
  13. Luoto R., Uutela A., Puska P. Occasional smoking increases total and cardiovascular mortality among men. Nicotine Tob Res. 2000 May;2(2):133–139. doi: 10.1080/713688127. [DOI] [PubMed] [Google Scholar]
  14. McGovern P. G., Pankow J. S., Shahar E., Doliszny K. M., Folsom A. R., Blackburn H., Luepker R. V. Recent trends in acute coronary heart disease--mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med. 1996 Apr 4;334(14):884–890. doi: 10.1056/NEJM199604043341403. [DOI] [PubMed] [Google Scholar]
  15. Osler M., Sørensen T. I., Sørensen S., Rostgaard K., Jensen G., Iversen L., Kristensen T. S., Madsen M. Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992. Int J Epidemiol. 1996 Dec;25(6):1154–1161. doi: 10.1093/ije/25.6.1154. [DOI] [PubMed] [Google Scholar]
  16. Prescott E., Scharling H., Osler M., Schnohr P. Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study. J Epidemiol Community Health. 2002 Sep;56(9):702–706. doi: 10.1136/jech.56.9.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sebregts E. H., Falger P. R., Bär F. W. Risk factor modification through nonpharmacological interventions in patients with coronary heart disease. J Psychosom Res. 2000 Apr-May;48(4-5):425–441. doi: 10.1016/s0022-3999(99)00113-0. [DOI] [PubMed] [Google Scholar]
  18. Smith C. J., Fischer T. H. Particulate and vapor phase constituents of cigarette mainstream smoke and risk of myocardial infarction. Atherosclerosis. 2001 Oct;158(2):257–267. doi: 10.1016/s0021-9150(01)00570-6. [DOI] [PubMed] [Google Scholar]
  19. Stamler J., Stamler R., Neaton J. D., Wentworth D., Daviglus M. L., Garside D., Dyer A. R., Liu K., Greenland P. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999 Dec 1;282(21):2012–2018. doi: 10.1001/jama.282.21.2012. [DOI] [PubMed] [Google Scholar]
  20. The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105–114. doi: 10.1016/0895-4356(88)90084-4. [DOI] [PubMed] [Google Scholar]
  21. Tunstall-Pedoe H., Kuulasmaa K., Mähönen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999 May 8;353(9164):1547–1557. doi: 10.1016/s0140-6736(99)04021-0. [DOI] [PubMed] [Google Scholar]
  22. Tverdal A. Calculation of risk for the development of acute myocardial infarction in the normal population based on long-term follow-up studies: smokers compared with non-smokers. J Cardiovasc Risk. 1999 Oct;6(5):287–291. doi: 10.1177/204748739900600502. [DOI] [PubMed] [Google Scholar]
  23. Wilson K., Gibson N., Willan A., Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med. 2000 Apr 10;160(7):939–944. doi: 10.1001/archinte.160.7.939. [DOI] [PubMed] [Google Scholar]
  24. Wood D. European and American recommendations for coronary heart disease prevention. Eur Heart J. 1998 Feb;19 (Suppl A):A12–A19. [PubMed] [Google Scholar]
  25. van Berkel T. F., van der Vlugt M. J., Boersma H. Characteristics of smokers and long-term changes in smoking behavior in consecutive patients with myocardial infarction. Prev Med. 2000 Dec;31(6):732–741. doi: 10.1006/pmed.2000.0755. [DOI] [PubMed] [Google Scholar]

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