Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports
Objective To use the relation between cigarette consumption and cardiovascular disease to quantify the risk of coronary heart disease and stroke for light smoking (one to five cigarettes/day).
Design Systematic review and meta-analysis.3
Data sources Medline 1946 to May 2015, with manual searches of references.
Eligibility criteria for selecting studies Prospective cohort studies with at least 50 events, reporting hazard ratios or relative risks (both hereafter referred to as relative risk) compared with never smokers or age specific incidence in relation to risk of coronary heart disease or stroke.
Results The meta-analysis included 55 publications containing 141 cohort studies. Among men, the pooled relative risk for coronary heart disease was 1.48 for smoking one cigarette per day and 2.04 for 20 cigarettes per day, using all studies, but 1.74 and 2.27 among studies in which the relative risk had been adjusted for multiple confounders. Among women, the pooled relative risks were 1.57 and 2.84 for one and 20 cigarettes per day (or 2.19 and 3.95 using relative risks adjusted for multiple factors). Men who smoked one cigarette per day had 46% of the excess relative risk for smoking 20 cigarettes per day (53% using relative risks adjusted for multiple factors), and women had 31% of the excess risk (38% using relative risks adjusted for multiple factors). For stroke, the pooled relative risks for men were 1.25 and 1.64 for smoking one or 20 cigarettes per day (1.30 and 1.56 using relative risks adjusted for multiple factors). In women, the pooled relative risks were 1.31 and 2.16 for smoking one or 20 cigarettes per day (1.46 and 2.42 using relative risks adjusted for multiple factors). The excess risk for stroke associated with one cigarette per day (in relation to 20 cigarettes per day) was 41% for men and 34% for women (or 64% and 36% using relative risks adjusted for multiple factors). Relative risks were generally higher among women than men.
Conclusions Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders.
Jede Reduktion ist grundsätzlich wichtig. Krebs- und COPD-Risiko wird sicher reduziert. Für die KHK-Prävention sollte man aber besser ganz aufhören.
Trotzdem sollten wir diese Info nutzen, um Patienten zum kompletten Aufhören zu motivieren. Wir machen es oft lustig.
Susanne: Herausfinden, welche Motivation sie haben, eventuell aufzuhören. Ob sie es schon mal geschafft haben. Und wenn, sie dafür zu loben.
Für eine Mindestmenge an Zigaretten, bei denen das Rauchen noch sicher ist, gibt es nicht. Selbst kleine Mengen sind noch überdurchschnittlich schädlich.
Wir sollten grundsätzlich zum absoluten Nikotinverzicht auffordern. Selbst drei Zigaretten pro Wochenende schaden.