Open Access Research article

Relative risk for cardiovascular atherosclerotic events after smoking cessation: 6–9 years excess risk in individuals with familial hypercholesterolemia

Anneke Kramer1, Angelique CM Jansen2, Emily S van Aalst-Cohen2, Michael WT Tanck3, John JP Kastelein2 and Aeilko H Zwinderman3*

Author Affiliations

1 Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands

2 Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands

3 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam PO Box 22700, 1100 DD Amsterdam, The Netherlands

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BMC Public Health 2006, 6:262  doi:10.1186/1471-2458-6-262

Published: 23 October 2006



Smoking history is often di- or trichotomized into for example "never, ever or current smoking". However, smoking must be treated as a time-dependent covariate when lifetime data is available. In particular, individuals do not smoke at birth, there is usually a wide variation with respect to smoking history, and smoking cessation must also be considered.


Therefore we analyzed smoking as a time-dependent risk factor for cardiovascular atherosclerotic events in a cohort of 2400 individuals with familial hypercholesterolemia who were followed from birth until 2004. Excess risk after smoking-cessation was modelled in a Cox regression model with linear and exponential decaying trends. The model with the highest likelihood value was used to estimate the decay of the excess risk of smoking.


Atherosclerotic events were observed in 779 patients with familial hypercholesterolemia and 1569 individuals had a smoking history. In the model with the highest likelihood value the risk reduction of smoking after cessation follows a linear pattern with time and it appears to take 6 to 9 years before the excess risk is reduced to zero. The risk of atherosclerotic events due to smoking was estimated as 2.1 (95% confidence interval 1.5; 2.9).


It was concluded that excess risk due to smoking declined linearly after cessation in at least six to nine years.