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. 2005 Jul 26;112(4):489-97.
doi: 10.1161/CIRCULATIONAHA.104.521708. Epub 2005 Jul 18.

Role of smoking in global and regional cardiovascular mortality

Majid Ezzati  1 , S Jane Henley, Michael J Thun, Alan D Lopez
Affiliations

Role of smoking in global and regional cardiovascular mortality

Majid Ezzati et al. Circulation. .

Abstract

Background: Smoking is a major cause of cardiovascular disease mortality. There is little information on how it contributes to global and regional cause-specific mortality from cardiovascular diseases for which background risk varies because of other risks.

Method and results: We used data from the American Cancer Society's Cancer Prevention Study II (CPS II) and the World Health Organization Global Burden of Disease mortality database to estimate smoking-attributable deaths from ischemic heart disease, cerebrovascular disease, and a cluster of other cardiovascular diseases for 14 epidemiological subregions of the world by age and sex. We used lung cancer mortality as an indirect marker for accumulated smoking hazard. CPS-II hazards were adjusted for important covariates. In the year 2000, an estimated 1.62 (95% CI, 1.27 to 2.04) million cardiovascular deaths in the world, 11% of total global cardiovascular deaths, were due to smoking. Of these, 1.17 million deaths were among men and 450,000 among women. There were 670,000 (95% CI, 440,000 to 920,000) smoking-attributable cardiovascular deaths in the developing world and 960,000 (95% CI, 770,000 to 1,200,000) in industrialized regions. Ischemic heart disease accounted for 54% of smoking-attributable cardiovascular mortality, followed by cerebrovascular disease (25%). There was variability across regions in the role of smoking as a cause of various cardiovascular diseases.

Conclusions: More than 1 in every 10 cardiovascular deaths in the world in the year 2000 were attributable to smoking, demonstrating that it is an important preventable cause of cardiovascular mortality.

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