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Smoking doubles the risk of premature heart disease

Kaiser Permanente research supports efforts to promote smoking cessation


Young adults who smoke cigarettes are twice as likely to develop premature heart disease as young adults who do not smoke, new Kaiser Permanente research shows.

The study, published November 17 in the American Journal of Preventive Medicine, highlights the importance of continued efforts to keep young people from starting to smoke cigarettes and to encourage those who do smoke to quit.

Jamal Rana, MD, PhD, adjunct investigator, Division of Research, and TPMG cardiologist.

“We hope this study helps to emphasize that when you smoke, you are greatly increasing your risk of having a heart attack or stroke at a younger age,” said the study’s lead author Jamal S. Rana, MD, PhD, an adjunct investigator with the Kaiser Permanente Division of Research and a cardiologist with The Permanente Medical Group.

The researchers used electronic medical records to identify 871,989 Kaiser Permanente Northern California members between the ages of 30 and 55 who had no history of atherosclerotic cardiovascular disease (ASCVD) in 2005. This type of heart disease occurs when fatty deposits, called plaque, build up in the arteries, increasing the risk of heart attack and stroke.

We hope this finding will draw attention to the need to educate young women that heart disease not only can start early but will ultimately cause 1 in 3 deaths in women.

— Jamal S. Rana, MD, PhD

Smoking is one of the key risk factors for ASCVD. To investigate whether smoking increases risk for ASCVD in young adults, the researchers used the electronic medical records to identify which individuals in the study were current, former, or never smokers. Then, they looked to see which study participants developed  ASCVD between 2005 and 2015. Overall, 13.7% of the young adults in the study were former smokers and 16.5% were current smokers. The analyses showed that the current smokers had more than two times the risk of developing ASCVD compared to the never smokers. The risk of developing ASCVD was lower in former smokers, but still higher than it was in never smokers.

These findings are especially important for women. In the U.S., 1 in 3 women will die from cardiovascular disease, and many will have lived with this disease for a long time. Studies show that 45% of women aged 20 and over have some form of heart disease. Yet, the number of women who are aware that heart disease is the leading cause of death in women has declined, from 64.8% in 2009 to 43.7% in 2019, with the greatest decline in women between the ages of 25 to 34 and in those who already have risk factors for cardiovascular disease.

“Our study showed that young adult women who smoked were also at a higher risk for premature heart disease,” said Rana. “We hope this finding will draw attention to the need to educate young women that heart disease not only can start early but will ultimately cause 1 in 3 deaths in women.”

Stephen Sidney, MD, MPH, research scientist, Division of Research.

Cigarette smoking is one of the leading causes of preventable disease and death in the U.S., with 1 in 5 deaths the result of a smoking-related disease. Although smoking rates have declined since the 1960s, when more than 40% of U.S. adults smoked, cigarette use remains common among young adults.

Since 2014, Kaiser Permanente Northern California has helped more than 200,000 members quit smoking. “Kaiser Permanente is committed to lowering smoking rates among its members,” said the study’s senior author Stephen Sidney, MD, MPH, a research scientist at the Division of Research. “Our study is yet another example of why this effort is so important.”

Co-authors include Howard H. Moffet, MPH, Jennifer Y. Liu, MPH, and Andrew J. Karter, PhD, of the Division of Research; Khurram Nasir, MD, MPH, of Houston Methodist; and Ron Blankstein, MD, of Harvard Medical School.

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About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

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