{"doi":"10.1093/eurheartj/ehad199","title":"Smoking habit change after cancer diagnosis: effect on cardiovascular risk","abstract":"Cancer survivors are rapidly increasing.1 There is a need for strategies against cardiovascular disease (CVD), the leading cause of death after surviving cancer.2 Despite the well-known adverse health effects of tobacco use, ∼20% of individuals diagnosed with cancer smoke persistently after the diagnosis.3,4 Yet, data are scarce regarding patterns and cardiovascular consequences of post-diagnosis smoking habit change among cancer survivors. From a nationwide, single-provider database of the Korean National Health Insurance Service,5 we identified 1 246 958 adults aged ≥20 newly diagnosed with cancer (having International Classification of Diseases, 10th revision [ICD-10] codes C00-C97 and critical condition code V193 for cancer)6 in 2006–13. Among 864 840 (69.4%) 3-year survivors, 320 353 underwent health examination each within 2 years before and within 3 years after cancer diagnosis. After excluding 3273 participants with missing data on covariables and 7985 with CVD event before the date of 3-year survival (index date), a final study cohort of 309 095 participants remained. This study complied with the Declaration of Helsinki and was approved by the Institutional Review Board of Severance Hospital, Seoul, Korea (Y-2021-0052) with a waiver of informed consent. Smoking status was assessed by a self-reported questionnaire during each of the last examination within 2 years before cancer (Exam 1) and the last examination within 3 years after cancer (Exam 2). Participants were categorized into four groups according to changes in smoking habits between Exams 1 and 2: (i) those who were not smoking in both exams were classified as ‘sustained non-smokers’; (ii) those who were smoking in Exam 1 but were not smoking in Exam 2 were classified as ‘quitters’; (iii) those who were not smoking in Exam 1 but were smoking in Exam 2 were classified as ‘initiators or relapsers’; and (iv) those who were smoking in both exams were classified as ‘continuing smokers’. The median (interquartile range) time interval between Exam 1 and cancer diagnosis was 0.5 (0.1–1.0) years, and that between cancer diagnosis and Exam 2 was 2.0 (1.6–2.5) years. The observed smoking habit changes were thereby considered to have occurred after cancer diagnosis. The primary outcome was a composite CVD event, defined as the first hospitalization for myocardial infarction (ICD-10: I21-I23) or stroke (ICD-10: I60-I64), or cardiovascular death (ICD-10: I00-I99) by 31 December 2019. Cumulative incidence of CVD events was estimated using subdistribution cumulative incidence function, accounting for a competing risk of non-cardiovascular death.7,8 Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using cause-specific Cox proportional hazards models, censoring participants at competing death events.8 Analyses used SAS 9.4 (SAS Institute Inc., Cary, NC, USA) and R 4.0.3 (R Foundation, Vienna, Austria). Of the 309 095 cancer survivors (median age, 59 years; 51.8% women), 250 102 (80.9%) sustained non-smoking, 31 121 (10.1%) quit smoking, 4777 (1.5%) initiated or relapsed to smoking, and 23 095 (7.5%) continued smoking after their respective cancer diagnoses. Patterns of smoking habit change varied across cancer types; the proportion of initiators/relapsers and continuing smokers combined was the highest among urinary tract (15.6%), male genital organ (14.2%), and hepatobiliary/pancreatic/other gastrointestinal (14.1%) cancer survivors, and was the lowest among breast (1.0%), female genital organ (2.1%), endocrine (5.7%), and lung (6.5%) cancer survivors (Figure 1A). Post-diagnosis smoking habit change and incident cardiovascular disease events among cancer survivors. (A) Patterns of smoking habit change according to cancer type. (B) Cumulative incidence of cardiovascular disease events according to smoking habit change. (C) Risk of cardiovascular disease events according to smoking habit change. Hazard ratios were adjusted for age, sex, househo","journal":"European Heart Journal","year":2023,"id":339779,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9608,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1073752,"name":"Hokyou Lee","orcid":"0000-0002-5034-8422","position":1,"is_corresponding":false},{"id":3774,"name":"Deepak L. Bhatt","orcid":"0000-0002-1278-6245","position":2,"is_corresponding":false},{"id":1073753,"name":"Ga Bin Lee","orcid":"0000-0001-6574-1414","position":3,"is_corresponding":false},{"id":1073754,"name":"Jiyen Han","orcid":"0000-0002-3020-7542","position":4,"is_corresponding":false},{"id":1073755,"name":"Dong Wook Shin","orcid":"0000-0001-8128-8920","position":5,"is_corresponding":false},{"id":1073756,"name":"Danbee Kang","orcid":"0000-0003-0244-7714","position":6,"is_corresponding":false},{"id":1073757,"name":"Jong‐Chan Youn","orcid":"0000-0003-0998-503X","position":7,"is_corresponding":false},{"id":231329,"name":"Eliseo Güallar","orcid":"0000-0002-4471-9565","position":8,"is_corresponding":false},{"id":512059,"name":"Juhee Cho","orcid":"0000-0001-9081-0266","position":9,"is_corresponding":false},{"id":1073758,"name":"Hyeon Chang Kim","orcid":"0000-0001-7867-1240","position":10,"is_corresponding":false},{"id":1073751,"name":"Hyeok‐Hee Lee","orcid":"0000-0002-2895-6835","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T01:10:49.535464Z","pmid":"37260198","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}