Prescribing Advice for GPs

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Smoking cessation and mortality

The Archives of Internal Medicine has published the results of a 22 year follow up of the Physicians' Health Study (PHS) to assess the effect of smoking cessation on total and cause-specific mortality.

PHS recruited 22,071 male US physicians between 1982 and 1984 and collected detailed information about smoking habits via a questionnaire 5 years into the study. This review analysed cause of death from death certificates for individuals who died between 3 years after the questionnaire and a fixed date of 9th March 2010. This review therefore included data for 19,705 individuals.

Crude mortality rates are 11.5 per 1,000 patient years for never smokers, 16.6 for ex-smokers and 26.1 for current smokers. Current smokers were at significantly higher risk of death from cardiovascular and pulmonary causes as well as lung cancer.

In ex-smokers, the risk of death was significantly reduced within 10 years of stopping smoking (Hazard Ratio 0.60, 95% CI 0.54-0.68) and this risk declined further by 20 years (HR 0.48, 95% CI 0.43-0.54). At 20 years the risk was not significantly different from that of individuals who had never smoked.

The paper includes several charts showing the risks of death from all, cardiovascular and pulmonary causes as well as several types of cancer. These charts may prove useful in communicating the risks of smoking and demonstrating the benefits of smoking cessation.

Action: Clinicians who encourage smoking cessation may find the data in this paper useful in illustrating the health benefits of stopping smoking.

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