Using the negative exponential distribution to quantitatively review the evidence on how rapidly the excess risk of ischaemic heart disease declines following quitting smoking

► No previous review has formally modelled the decline in IHD risk following quitting smoking. ► We estimated when the excess risk becomes half that of continuing smoking (the half-life H). ► Based on 41 independent data blocks we estimated H as 4.40 (95% CI 3.26 to 5.95) years. ► Individual estimat...

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Veröffentlicht in:Regulatory toxicology and pharmacology 2012-10, Vol.64 (1), p.51-67
Hauptverfasser: Lee, Peter N., Fry, John S., Hamling, Jan S.
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Fry, John S.
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description ► No previous review has formally modelled the decline in IHD risk following quitting smoking. ► We estimated when the excess risk becomes half that of continuing smoking (the half-life H). ► Based on 41 independent data blocks we estimated H as 4.40 (95% CI 3.26 to 5.95) years. ► Individual estimates are extremely variable: 10years for 12 blocks. ► Claims that excess risk approximately halves after quitting for 1year do not reflect the overall data. No previous review has formally modelled the decline in IHD risk following quitting smoking. From PubMed searches and other sources we identified 15 prospective and eight case-control studies that compared IHD risk in current smokers, never smokers, and quitters by time period of quit, some studies providing separate blocks of results by sex, age or amount smoked. For each of 41 independent blocks, we estimated, using the negative exponential model, the time, H, when the excess risk reduced to half that caused by smoking. Goodness-of-fit to the model was adequate for 35 blocks, others showing a non-monotonic pattern of decline following quitting, with a variable pattern of misfit. After omitting one block with a current smoker RR 1.0, the combined H estimate was 4.40 (95% CI 3.26–5.95) years. There was considerable heterogeneity, H being 10years for 12. H increased (p
doi_str_mv 10.1016/j.yrtph.2012.06.009
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No previous review has formally modelled the decline in IHD risk following quitting smoking. From PubMed searches and other sources we identified 15 prospective and eight case-control studies that compared IHD risk in current smokers, never smokers, and quitters by time period of quit, some studies providing separate blocks of results by sex, age or amount smoked. For each of 41 independent blocks, we estimated, using the negative exponential model, the time, H, when the excess risk reduced to half that caused by smoking. Goodness-of-fit to the model was adequate for 35 blocks, others showing a non-monotonic pattern of decline following quitting, with a variable pattern of misfit. After omitting one block with a current smoker RR 1.0, the combined H estimate was 4.40 (95% CI 3.26–5.95) years. There was considerable heterogeneity, H being &lt;2years for 10 blocks and &gt;10years for 12. H increased (p&lt;0.001) with mean age at study start, but not clearly with other factors. Sensitivity analyses allowing for reverse causation, or varying assumed midpoint times for the final open-ended quitting period little affected goodness-of-fit of the combined estimate. 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No previous review has formally modelled the decline in IHD risk following quitting smoking. From PubMed searches and other sources we identified 15 prospective and eight case-control studies that compared IHD risk in current smokers, never smokers, and quitters by time period of quit, some studies providing separate blocks of results by sex, age or amount smoked. For each of 41 independent blocks, we estimated, using the negative exponential model, the time, H, when the excess risk reduced to half that caused by smoking. Goodness-of-fit to the model was adequate for 35 blocks, others showing a non-monotonic pattern of decline following quitting, with a variable pattern of misfit. After omitting one block with a current smoker RR 1.0, the combined H estimate was 4.40 (95% CI 3.26–5.95) years. There was considerable heterogeneity, H being &lt;2years for 10 blocks and &gt;10years for 12. H increased (p&lt;0.001) with mean age at study start, but not clearly with other factors. Sensitivity analyses allowing for reverse causation, or varying assumed midpoint times for the final open-ended quitting period little affected goodness-of-fit of the combined estimate. 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numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Peter N.</creatorcontrib><creatorcontrib>Fry, John S.</creatorcontrib><creatorcontrib>Hamling, Jan S.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Environment Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Environment Abstracts</collection><jtitle>Regulatory toxicology and pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Peter N.</au><au>Fry, John S.</au><au>Hamling, Jan S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Using the negative exponential distribution to quantitatively review the evidence on how rapidly the excess risk of ischaemic heart disease declines following quitting smoking</atitle><jtitle>Regulatory toxicology and pharmacology</jtitle><addtitle>Regul Toxicol Pharmacol</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>64</volume><issue>1</issue><spage>51</spage><epage>67</epage><pages>51-67</pages><issn>0273-2300</issn><eissn>1096-0295</eissn><abstract>► No previous review has formally modelled the decline in IHD risk following quitting smoking. ► We estimated when the excess risk becomes half that of continuing smoking (the half-life H). ► Based on 41 independent data blocks we estimated H as 4.40 (95% CI 3.26 to 5.95) years. ► Individual estimates are extremely variable: &lt;2years for 10 blocks and &gt;10years for 12 blocks. ► Claims that excess risk approximately halves after quitting for 1year do not reflect the overall data. 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subjects Female
Half-Life
Humans
Ischaemic heart disease
Male
Meta-analysis
Models, Statistical
Myocardial Ischemia - epidemiology
Myocardial Ischemia - etiology
Myocardial Ischemia - metabolism
Negative exponential distribution
Quitting
Reverse causation
Review
Risk Assessment
Smoke - adverse effects
Smoking
Smoking - adverse effects
Smoking - epidemiology
Smoking - metabolism
Smoking Cessation - statistics & numerical data
title Using the negative exponential distribution to quantitatively review the evidence on how rapidly the excess risk of ischaemic heart disease declines following quitting smoking
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