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Smoking and atherosclerotic cardiovascular disease risk in young men: the Korean Life Course Health Study

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Author(s): Yongho Jee ¹ , Keum Ji Jung ² , Sunmi Lee ³ , Joung Hwan Back ⁴ , Sun Ha Jee ⁵ , Sung-il Cho ¹

Publication date (Electronic): 12 June 2019

Journal: BMJ Open

Publisher: BMJ Publishing Group

Keywords: smoking, cardiovascular disease, young adults

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Abstract

Objective

To examine the effect of smoking on risk of atherosclerotic cardiovascular disease (ASCVD) in Korean young men and to examine whether serum total cholesterol levels could modify the effect of smoking on ASCVD.

Design

A prospective cohort study within a national insurance system.

Setting

Health screenings provided by national insurance in 1992 and 1994.

Participants

A total of 118 531 young men between 20 and 29 years of age and were followed up for an average of 23 years.

Outcome measure

To assess the independent effects of smoking on the risk of ischaemic heart disease (IHD), stroke and ASCVD, Cox proportional hazards regression models were used, controlling for age, hypertension, diabetes, hypercholesterolaemia and alcohol drinking.

Results

The total number of current smokers was 78 455 (66.2%), and 94 113 (79.7%) of the sample recorded a total cholesterol level <200 mg/dL measured at baseline. Between 1993 and 2015, 2786 cases of IHD (53/100 000 person year), 2368 cases of stroke (45.4/100 000 person year) and 6368 ASCVD (122.7/100 000 person year) occurred. The risk of IHD, stroke and total ASCVD events was found to increase for current smokers, with a HR with 95% CI of 1.5 (95% CI 1.3 to 1.6), 1.4 (95% CI 1.2 to 1.6) and 1.4 (95% CI 1.3 to 1.5), respectively. Furthermore, the risks above were also found throughout the range of serum levels of cholesterol.

Conclusions

Smoking among Korean young adult men was independently associated with increased risk of IHD, stroke and ASCVD. The concentration of cholesterol in Korean men did not modify the effect of smoking on ASCVD.

Related collections

Most cited references 21

Record: found
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Article: not found

The occurrence of lung cancer in man.

M L Levin (1953)

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Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths.

B Q Liu, R Peto, Z M Chen … (1998)

To assess the hazards at an early phase of the growing epidemic of deaths from tobacco in China. Smoking habits before 1980 (obtained from family or other informants) of 0.7 million adults who had died of neoplastic, respiratory, or vascular causes were compared with those of a reference group of 0.2 million who had died of other causes. 24 urban and 74 rural areas of China. One million people who had died during 1986-8 and whose families could be interviewed. Tobacco attributable mortality in middle or old age from neoplastic, respiratory, or vascular disease. Among male smokers aged 35-69 there was a 51% (SE 2) excess of neoplastic deaths, a 31% (2) excess of respiratory deaths, and a 15% (2) excess of vascular deaths. All three excesses were significant (P /70 there was a 39% (3) excess of neoplastic deaths, a 54% (2) excess of respiratory deaths, and a 6% (2) excess of vascular deaths. Fewer women smoked, but those who did had tobacco attributable risks of lung cancer and respiratory disease about the same as men. For both sexes, the lung cancer rates at ages 35-69 were about three times as great in smokers as in non-smokers, but because the rates among non-smokers in different parts of China varied widely the absolute excesses of lung cancer in smokers also varied. Of all deaths attributed to tobacco, 45% were due to chronic obstructive pulmonary disease and 15% to lung cancer; oesophageal cancer, stomach cancer, liver cancer, tuberculosis, stroke, and ischaemic heart disease each caused 5-8%. Tobacco caused about 0.6 million Chinese deaths in 1990 (0.5 million men). This will rise to 0.8 million in 2000 (0.4 million at ages 35-69) or to more if the tobacco attributed fractions increase. At current age specific death rates in smokers and non-smokers one in four smokers would be killed by tobacco, but as the epidemic grows this proportion will roughly double. If current smoking uptake rates persist in China (where about two thirds of men but few women become smokers) tobacco will kill about 100 million of the 0.3 billion males now aged 0-29, with half these deaths in middle age and half in old age.

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Validity of the Diagnosis of Acute Myocardial Infarction in Korean National Medical Health Insurance Claims Data: The Korean Heart Study (1)

Heejin Kimm, Ji Yun, Sang-Hak Lee … (2012)

Background and Objectives Medical insurance claims (MIC) data are one of the largest sources of outcome data in the form of International Classification of Diseases (ICD) codes. We evaluated the validity of the ICD codes from the Korean National MIC data with respect to the outcomes from acute myocardial infarction (AMI) in the Korean Heart Study. Subjects and Methods Baseline information was obtained from health examinations conducted from 1994 to 2001. Outcome information regarding the incidence of AMI came from hospital admission discharge records from 1994 to 2007. Structured questionnaires were sent to 98 hospitals. In total, 107 cases of AMI with ICD codes of I21- (93 men, 26-73 years of age) were included in the final analyses. ICD code accuracy and reliability (kappa) for AMI were calculated. Results A large number of AMI cases were from hospitals located in the Seoul area (75.9%). The accuracy of AMI was 71.4%, according to World Health Organization criteria (1997-2000, n=24, kappa=0.46) and 73.1% according to the European Society of Cardiology/American College of Cardiology (ESC/ACC) criteria (2001-2007, n=83, kappa=0.74). An age of 50 years or older was the only factor related to inaccuracy of codes for AMI (odds ratio, 4.6; 95% confidence interval, 1.2-17.7) in patients diagnosed since January 2001 using ESC/ACC criteria (n=83). Conclusion The accuracy for diagnosing AMI using the ICD-10 codes in Korean MIC data was >70%, and reliability was fair to good; however, more attention is required for recoding ICD codes in older patients.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 12 June 2019

Volume: 9

Issue: 6

Electronic Location Identifier: e024453

Affiliations

[1 ] departmentDepartment of Public Health Science , Graduate School of Public Health, Seoul National University , Seoul, The Republic of Korea

[2 ] departmentInstitute for Health Promotion , Graduate School of Public Health, Yonsei University , Seoul, The Republic of Korea

[3 ] departmentHealth Insurance Policy Research Institute , National Health Insurance Service , Wonju, Gangwon-do, The Republic of Korea

[4 ] departmentWonju Gangwon-do, The Republic of Korea Wonju Gangwon-do , The Republic of Korea Health Insurance Policy Research Institute, National Health Insurance Service, Wonju Gangwon-do, The Republic of Korea

[5 ] departmentDepartment of Epidemiology and Health Promotion , Graduate School of Public Health, Yonsei University , Seoul, The Republic of Korea

Author notes

[Correspondence to ] Sung-il Cho; scho@ 123456snu.ac.kr

Author information

Keum Ji Jung http://orcid.org/0000-0003-4993-0666

Article

Publisher ID: bmjopen-2018-024453

DOI: 10.1136/bmjopen-2018-024453

PMC ID: 6575821

PubMed ID: 31196897

SO-VID: 7e65295f-3bd5-4319-9e35-d6629614e9ae

Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 06 June 2018

Date revision received : 16 February 2019

Date accepted : 21 February 2019

Funding

Funded by: Grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea;

Categories

Subject: Epidemiology

Subject: Research

Subject: 1506

Subject: 1692

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ScienceOpen disciplines: Medicine

Keywords: smoking,cardiovascular disease,young adults

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ScienceOpen disciplines: Medicine

Keywords: smoking, cardiovascular disease, young adults

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