IJE Advance Access originally published online on May 24, 2005
International Journal of Epidemiology 2005 34(5):1036-1045; doi:10.1093/ije/dyi104
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Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region
Asia Pacific Cohort Studies Collaboration
,*
Writing committee: M Woodward, TH Lam, F Barzi, A Patel, D Gu, A Rodgers, Il Suh. Executive committee: DF Gu, TH Lam, CMM Lawes, SW MacMahon, WH Pan, A Rodgers, I Suh, H Ueshima, M Woodward. Statistical analyses: F Barzi, V Parag, M Woodward. Participating studies and principal collaborators: Aito Town: A Okayama, H Ueshima, H Maegawa; Akabane: N Aoki, M Nakamura, N Kubo, T Yamada; Anzhen02: ZS Wu; Anzhen: CH Yao, ZS Wu; Australian Longitudinal Study of Aging: G Andrews; Australian National Heart Foundation: TA Welborn; Beijing Aging: Z Tang; Beijing Steelworkers: LS Liu, JX Xie; Blood Donors' Health: R Norton, S Ameratunga, S MacMahon, G Whitlock; Busselton: MW Knuiman; Canberra-Queanbeyan: H. Christensen; Capital Iron and Steel Company: XG Wu; CISCH: J Zhou, XH Yu; Civil Service Workers: A Tamakoshi; CVDFACTS: WH Pan; East Beijing: ZL Wu, LQ Chen, GL Shan; EGAT: P Sritara; Fangshan: DF Gu, XF Duan; Fletcher Challenge: S MacMahon, R Norton, G Whitlock, R Jackson; Guangzhou: YH Li; Guangzhou Occupational: TH Lam, CQ Jiang; Hisayama: M Fujishima, Y Kiyohara, H Iwamoto; Hong Kong: J Woo, SC Ho; Huashan: Z Hong, MS Huang, B Zhou; Kinmen: JL Fuh; Konan: H Ueshima, Y Kita, SR Choudhury; KMIC: I Suh, SH Jee, IS Kim; Melbourne: G Giles; Miyama: T Hashimoto, K Sakata; Newcastle: A Dobson; Ohasama: Y Imai, T Ohkubo, A Hozawa; Perth: K Jamrozik, M Hobbs, R Broadhurst; Saitama: K Nakachi; Seven Cities: XH Fang, SC Li, QD Yang; Shanghai Factory Workers: ZM Chen; Shibata: H Tanaka; Shigaraki Town: Y Kita, A Nozaki, H Ueshima; Shirakawa: H Horibe, Y Matsutani, M Kagaya; Singapore Heart: K Hughes, J Lee; Singapore NHS92: D Heng, SK Chew; Six Cohorts: BF Zhou, HY Zhang; Tanno/Soubetsu: K Shimamoto, S Saitoh; Tianjin: ZZ Li, HY Zhang; Western Australia AAA Screenees: P Norman, K Jamrozik; Xi'an: Y He, TH Lam; Yunnan: SX Yao. (The italicized studies provided data used in this paper)
* Corresponding author. Mark Woodward, The George Institute for International Health, The University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. E-mail: mwoodward{at}thegeorgeinstitute.org
Accepted 21 April 2005
Background Although smoking is a major risk factor for cardiovascular disease, it has been suggested that Asians may be less susceptible to the adverse effects of smoking than Caucasians. This may have contributed to the high prevalence of smoking, and the low quitting rates, in Asian men. Worldwide, smoking rates are increasing for women, amongst whom cardiovascular awareness is relatively poor.
Methods An individual participant data analysis of 40 cohort studies was carried out, involving 463 674 Asians (33% female) and 98 664 Australasians (45% female). Cox proportional hazard models, stratified by study and sex where appropriate, were employed.
Results The HR [95% confidence interval (CI)], comparing current smokers with non-smokers, for coronary heart disease (CHD) was 1.60 (1.49–1.72); haemorrhagic stroke 1.19 (1.06–1.33); ischaemic stroke 1.38 (1.24–1.54). There was a clear dose–response relationship between the number of cigarettes smoked per day and both CHD and stroke, with no significant difference (P 
0.20) between populations from Asia and Australia/New Zealand. Although there was no sex difference for stroke in the effect of amount smoked (P = 0.16), for CHD, women tended to have higher hazard ratios than men (P = 0.011). Quitting gave a clear benefit, which was not significantly different between the sexes or regions (P > 0.63). The HR (CI) for ex-smokers compared with current smokers was 0.71 (0.64–0.78) for CHD and 0.84 (0.76–0.92) for stroke.
Conclusions Unless urgent public health measures are put into place, the impact of the smoking epidemic in Asia, and among women, will be enormous. Tobacco control policies that specifically target these populations are essential.
Keywords Smoking, coronary heart disease, stroke, Asia
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