BackgroundCigarette smoking is significantly associated with premature death related and not related to cardiovascular disease (CVD). Whether risk associated with smoking is similar across CVD subtypes and how this translates into years of life lost is not known.Methods and ResultsWe pooled and harmonized individual‐level data from 9 population‐based cohorts in the United States. All participants were free of clinical CVD at baseline with available data on current smoking status, covariates, and CVD outcomes. We examined the association between smoking status and total CVD and CVD subtypes, including fatal and nonfatal coronary heart disease, stroke, congestive heart failure, and other CVD deaths. We performed (1) modified Kaplan–Meier analysis to estimate long‐term risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CVD or noncardiovascular death, and (3) Irwin’s restricted mean to estimate years lived free from and with CVD. Of 106 165 adults, 50.4% were women. Overall long‐term risks for CVD events were 46.0% (95% CI, 44.7–47.3) and 34.7% (95% CI, 33.3–36.0) in middle‐aged men and women, respectively. In middle‐aged men who reported smoking compared with those who did not smoke, competing hazard ratios (HRs) were higher for the first presentation being a fatal CVD event (HR, 1.79 [95% CI, 1.68–1.92]), with a similar pattern among women (HR,1.82 [95% CI, 1.68–1.98]). Smoking was associated with earlier CVD onset by 5.1 and 3.8 years in men and women. Similar patterns were observed in younger and older adults.ConclusionsCurrent smoking was associated with a fatal event as the first manifestation of clinical CVD.

中文翻译：

---

在整个生命过程中吸烟和致命和非致命心血管疾病亚型的竞争风险

背景吸烟与过早死亡显着相关，但与心血管疾病（CVD）无关。与吸烟相关的风险在 CVD 亚型中是否相似以及这如何转化为寿命损失年数尚不清楚。方法和结果我们汇总并协调了来自美国 9 个基于人群的队列的个体水平数据。所有参与者在基线时都没有临床 CVD，并有关于当前吸烟状况、协变量和 CVD 结果的可用数据。我们检查了吸烟状况与总 CVD 和 CVD 亚型之间的关联，包括致命和非致命的冠心病、中风、充血性心力衰竭和其他 CVD 死亡。我们进行了 (1) 修正的 Kaplan-Meier 分析来估计长期风险，(2) 调整竞争 Cox 模型以估计 CVD 或非心血管死亡的联合累积风险，以及 (3) Irwin 的限制平均值来估计无 CVD 和有 CVD 的年数。在 106 165 名成年人中，50.4% 是女性。中年男性和女性心血管事件的总体长期风险分别为 46.0%（95% CI，44.7-47.3）和 34.7%（95% CI，33.3-36.0）。与不吸烟的中年男性相比，在报告吸烟的中年男性中，首次出现致命性 CVD 事件的竞争风险比 (HR) 较高（HR，1.79 [95% CI，1.68–1.92]），女性中的相似模式（HR，1.82 [95% CI，1.68–1.98]）。在男性和女性中，吸烟与 5.1 年和 3.8 年的早期 CVD 发病有关。在年轻人和老年人中观察到类似的模式。