Latest perspectives on cigarette smoking and cardiovascular disease: the Framingham study. 

Kannel, et al. J Card Rehabil. 1984;4:267–77.



During the 26 years of biennial examinations of the Framingham cohort, over 1,500 new cases of cardiovascular events occurred; 750 deaths due to cardiovascular disease were noted. During the follow-up period, almost 40% of the men who were smoking cigarettes at the initial examination reported that they were no longer smoking at the tenth biennial examination. The noted increased risk of cardiovascular disease associated with cigarette smoking decreased with age for every event studied. Nevertheless, among middle-aged smokers, risk of coronary attacks and occlusive peripheral arterial disease at least doubled for those who smoked cigarettes. Smoking cigarettes also doubled the risk of premature strokes in men and doubled the risk of cardiac failure in women. Risk of sudden death increased more than tenfold in men and almost fivefold in women who smoked. Although the risk of myocardial infarction also increased (almost fourfold in men), a relationship with angina could not be found. The impact of cigarette smoking is greatest for occlusive peripheral arterial disease. Those who quit smoking reverted to only half the risk of those who continued to smoke, for recurrent as well as first coronary heart disease events. The benefits of quitting cigarette smoking rival those of cardiac surgery and cardiovascular drugs.