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Nonamokers EX = kx-smokers] Author, year, Number ond Data country, type of collection Cases (percent) Controls (percent) Comments reference population English 1,000 males with Case selection clge Percent Smolers Percent Smokers etal, manifest CHD, from Mayo 40-49 wee THT CLBT) 61,9 (302) (p<0.001) 1940, 40 ye ‘sof age, Founda- 50 49 71.7 (382) 73.9(371) (not significant) U.S.A. Conticla: 1,000 tion files. G0 or over + G4R (431) 61.8 (327) (not significant) {60). male noneCHD Controls: Alluges » GOK 66.3 (p<0.06) patients, wame year of udmis- sion age matched, Mills and 474 white male Undefined. 40-49 50-59 60-69 7Oorover 40-49 50-59 60-69 70 or over Porter, coronary deaths. (58) (135) (153) (130) (216) (188) (id) (83) 1967, Controls: 606 NS tenaee LTA 6.66 18.30 35.84 19.91 24,47 35.09 64,12 U.S.A, white males, Allcigarettes os... ees 83.93 82,23 45.02 18.44 70,83 89.94 43.86 16.47 (isi), Pipes, cigars 8.93 HLL 32.68 47.70 9.26 16.47 21.05 25.41 Buechley Males reporting Question- 20.4 (23) NS veneers AZL(BE) etal. CHD to California natre and . GLY (69) M20 ee eee AGT (56) 1958, Health Survey interview. 18.5 (21) seeve ee Lh6 (14) U.S.A. with matched (39). controls from Bame survey (included those surviving first myocardial infarction). 06 TABLE A6.—Coronary heart discase morbidity and mortality—retrospective studies (cont.) (SM = Smokers (Actual number of cases shown in parentheses)? NS = Nensmokers EX = Ex-smokers]} Author, year, Number and Data country, type of collection Cases (percent) Controls (percent} Comments reference Dopulation Russek and 97 male and 3 Interviews Tobacco waaye>9u cigurettcs/day Patients Zohman, female coronary by 70 percent. 35 percent. included 99 1958, patients, Controls: authors, with classical USA. 100 healthy controls myocardial (169), of similar age, infarction sex, occupation, and li with and ethnic origin. Angina pectoris. Spain and 269 males identified 3,000 males NS... 8000 (BL) 29,0 (172) Nathan, as having CHD by in New <40/day seen 29.0 (7B) 33.0 (870) 1961, physicalexumination York City >40/day ....,....13.0 (93) 9.0 (234) (p<0.06) U.S.A. and history. Controls: interes EX ooe cece 14.0 (99) 14.0 (361) (176). 2,637/3,000 males Viewed and Cigar, pipe .......14.0 (38) 16.0 (400) identified as examined Total wo... 100,0(269) 100.0( 2,637) not having CHD by medical group. Muleahy and 400 ma‘-s less than Interview, Matca Males Control smoking Hickey, 60 years of age with . 4.60 (18) 18,2(110) data obtnined 1967 elussical CHD. Data \ . 90.76 (363) 70,6 (427) from estimnted Treland compared with male ties 4.75 (19) 11.2 (68) amoking habits (35,146). population con. » 100,00 (400) 100.0(605) of Irish sumption figures. population of same age group. Schwartz 612 male patients Interview, Average amount 18.8 (p<0.0001) Data apply only to etal, with angina or laboratory, per day as 6.0 those under $5 1966, myocardial and cigarettes ...,,. 18.6 yeurs of age. France infarction, cliniealexs ANISM ,.... (169). 612 age-matched aminations, Inhalers ......... »69.0 controls, 45,0(p<0,00001) 16 TABLE AG.—Coronary heart discase morbidity and mortality—retrospective studies (cont.) {Actual number of cases shown In parentheses)? (SM = Smokers NS = Nonamokera EX = Ex-smokeras] Author, year, Number and Data country, type of collection Cases (percent) Controls (percent) Comments reference population Villiger and 100 casey with Hospital Malea(7%) Femalea(23) Malea(72) Females (28) Theye are not pure Heyden- recent myocardial history or NS viccece scene Servet e ewe res 6.94 Wd $26.0 82.1 amoking classes. Stucky, infarctions, interview, Cigarettes... cece cece eseneaee 66.7 28.6 45.8 14.3 tip<0.01) 1966, 72 malex, 28 females, 1-19 cigarettca/day ............, 1B. 10.7 23.6 10.7 Swit- 100 age-matched >20 79 $22.2 36 ger. controls (72 male Cigar, pipe 27.8 oe land industrial EX $16.3 3.6 (201). employees and 28 females in hospital for other dingnoses), Dorken, 205 males up to 44 Death cer- NS wiv... 1.0 (2) 18.4 (76) Ex-samokers listed 1967, years of age with tificate re- Cigarette Unita under nonsmokers, Germany myocardial infarc- view. In- 1-5 usec eee eee. 1B (38) 10.4 (43) Smoking information (52). tion or sudden terview of WO-18 o....5260...92.2 (62) 46.5 (192) available only on death (139 deceased, patient 20-30 2 ....06605..43,8 (84) 22.5 (93) 199/205. These 66 living). Controls or kin. 8B eee eee eee 21.8 (42) 22 (9) cigarette categories —Hamburg age- 100.0(193) . 100.0(413) include nvined ov cigar matched citizens * (only 28 were mixed (62 were mixed or smokers recaleuinated selected randomly, or cigar smokers) cigar smokers) as tu number of ciga- rettus. No patients or controls smoked pipes exclusively. Dorken, 33 females up to Death cer- Cigarettes per day 1967, 44 years of age tificates, DO eerseaeeee eee BL (2) 63.2(84) (p<0.001) Germany with myocardial inter. 1-5 . 17,3 (23) (53). infarction or sudden views, 6-15 - 48.5 (16) 16.5 (22) death. Controls—133 20-380... cee. 39.4 (13} 8.0 (4) formales 27-44 years >36 G1 (2) of age from clinic without CVD or lung cancer, Z6 TABLE AG.—Coronary heart disease morbidity and mortality—retrospective studies (cont.) (SM = Smokers (Actual number of cases shown in parentheses)? NS = Nonsmokers EX = Ex-smokers] Author, year, Number and Data country, type of collection Cases (percent) Controls (percent) Comments reference population Hyams 79 males surviving Interviews NS voce e cece eee 10.1 (9) 21.0 (33) etal, myocardial infarc by trained 1-9 cigarettes 1967, tion. 157 ages personnel, per day 10,5 (13) Japan matched controls 10-15 2.0... 33.9 (42) (87), hospitalized for non- 16-20 J... cee ae 26.8 (32) CVD but include 21-44... 17.7 (22) hypertensive disease, D836 w... 12.2 (15) ALL SM vo ees 200.0 (Th) 100.0(124) Mulcahy 100 female patients Hospital SM vevec cess eee 83.0 (69) 45.6 (261) Smoking on controls etal, Jess than 60 years interviews. NS . 33.0 (33) 45.3 (259) obtained from 1967, of age admitted to EX w.eceaaee > 400 (4) 9.1 ($2) stulistics of Treland hospital with CHD. Total ..... 100.0(100) 100.0 (572) emoking in (137) Trish Repubtic, Sudden death not ineluded, Stejfa, 70 male and Direct Prevalence of risk factors Authors then fullowed 1967, female patients interviews. Angina patients Control group the 70 puticnts for Poland with recent onset 60.0 3 years and noted (179). exertional angina 48.1¢p>0.1) that smoking signifi- pectoris, 54 controls cantly influenced of same age, the incidence of coronary occlusion, Schimmler 503 males with Hospital NS reves 90 (44) 26.0(187) (p<0.001) etal, healed myocardial interviews, EX ......... ..12,0 (59) 20.0(142) (p<0.001) 1968, infarctions. 714 male Cigar, pipe ...... 12.0 (62) 14.0 (77) Germany controls of same age <19 cigarettes ~ .25,0(129) 14.0(101) (n<0.001) (267). without detectable 20 ccc ee ee 42.0 (209) 29,0(207) (p<0.001) heart disease. Total .,..,100,0(503) 100.0(714) oO We TABLE AG.—Coronary heart disease morbidily anid nrortality—retrospective atudies (cont.) (Actual number of casey shown in parenthoves) + {SM = Smokers NS = Nonsmokers EX = Exeamokers} Author, year, Number and Data country, type of collection Cases (percent) Controls (percent) Comments teference population Hoodetal., 230 males surviving Interview ' (230) (865) 1969, early first myocardia) and exam- Never smoked ....1.75 24.2 Sweden infarction, Controls: ination. EX before (85). 855 randomly selected infarction ...... 1.75 , 19.7 males 50 years of EX after age. infarction .....29.1 <6 cigarettes ...28.3 27.4 >15 cigarettes ...22.6 20,0 All cece cee eee 80.0 47.4 Pipe .........00, 16.5 8.8 Jouve 1,229 CHD patients: Interview. 43.0 13.0(p<0.0001) etal, 802 males, 427 1969, females. Controls: France 743 individuals of (91). both sexes; age, aex, and social class matched, Kastl, 275 male railway Interview NS wee trae 20.0 (65) 29.8 (82) 1969, employees up to 65 and exe 2-20 cigarettes or Germany years of age sur- amina- up to 6 cigars.. ..92.0 (88) 63.3 (82) (92). viving myocardial tion. >20 cigarettes or infarction. 275 con- >6 cigars, .......48.0(192) 6.9 (19) trol employees with minor circulatory disturbances, Unless otherwise specified, disparities between the total number of cases and the sum of the individual smoking categories are due to the exclusion of either occasional, miscellaneous, mixed, or ex-smokers, 76 TABLE A7,—Differences in serum lipids between smokers and nonsmokers (Actual number of individuals shown in parentheses)! [SM = Smokers NS = Nonsmokers] Author, year, Number and country, type of Results Comments reference population Gofman 401 male Difference between SA and NS tSf refers to Svedberg etal, employecs Ages 20~29 Ages 30-39 Ageas0-59 flotation units of 1955, 20-59 years Lipid: (NS 55, SM 37) (NS 66, SM 67) (NS 17, SM 44) centrifuged Jipoproteing, U.S.A, of age. St 0-12 +s $59.9 p0.00l +19.9 p0.0s + 39 p<0.05 (72£), Sf 12-20 > $+ 9.4 poo.ool + 5.4 pco.0s — 3.5 p<0.05 Sf 20-100 + $20.0 p0.025 + 9.1 p<0.05 + 8.5 p0.05 Sf 100-400 - +15.8 p0.025 +121 po0.0s — 4.5 pf0.05 Cholesterol » $212 p0.0s + 9,0 pco.0s — 4.8 p<0.05 Thomas, 521 medical Serum cholecaterol mg, percent 1958, students. NS (264) SM (257) U.S.A. Observed/Expected Obeerved/Expeeted (185). <250 170/157 149/161.6 >250 Se Cree eee eae es 87/$9.6 115/102.4 Chi Square Value = 5.2 p<0.025 Dawber 2,253 males Scrum cholesterol mg. percent The authors conclude that etal., participating 29-h4 45-59 there is evidence of a 1959, inthe Framingham NS bee 216.1 (149) 228,3(131) gradient of cholesterol with U.S.A. study 29-59 All cigarettes 224.8 (874) 229.5 (589) increasing amount of cigarctle (47), years of age. sees 2IT.4 (75) 229.1 (76) smoking in younger men, \ soe 2201 (194) 230.1 (96) 226.8(651) 227,8(350) 229.0(114) 258.5 (68) 2149(128) 227.1 (166) Karvonen 526 males in Serum cholesterol my. percent The authors slate that no etal, various Weat Finland Rust Finland Heloinki trend was note mssocinting 1959, becupntions NS ieee c cect eee te ner yenes 208,0(64) 226.0 (39) 235.1 (62) increasing aniwunt smoked with Finland 20-59 yours SM Cece treet ences QAR COED 249.7(103) 257.8(166) increasing serum cholestero}, (97), of age, although smokers and nonsmokers did have different overall levels S6 TABLE A7.—Differcnces in serum lipids between smokers and nonsmokers (cont.) (Actual number of individuals shown in parentheses)! {SM = Smokers NS = Nonsmokers] Author, year, Number and country, type of NResulty Comments reference population Acheson 221 randomly Mean aerum cholesterol Mean Beta/Alpha and Jessap, chosen pensioners mg. percent Upoprotein ratio 16! 65-85 years of NS ccc eee cette ete ve es 2440638) 2.0(36) Ireland age, Secigavettes/day oo... .c ce cece eee eres 201(12) 20012) (fh). VD cece cece ee eter renee 213 (94) 1.9(33) 20 eee etree eter tener neces 201639) 1.9 (35) P30 ete teense eee 206 (8) 1.8 (8) Bronte Approximately Cholestcral mg. percent Retu/ Alpha Upoprotein ratio No data given on numbers in Stewart, G00 healthy 25-39 40-55 25-39 40-55 each group, 1961, mules 25~55 tA tk A BE A E A E tA—Afriean, South years of age, NS ww... eee. 179 197 222 0 246 249 3.34 3.76 4.69 tE—European, Alrion “Heuvy' SM... 1K6 220 204 236 3.82 4.40 4.07 5.40 (gst) Kontlinen, 314 male military Scrum cholesterol Serum phospholipids No serum lipid differences 162, reeruity 18-25 mg. pereent mg, percent found omong the various Finland years of age. NS ccc ee eee CUS) eee eee eens 200.8 218.0 smoking groups, (1g), (Cigarettes per day) 1-10 (83)..........,5.. 200.8 222.3 11-19 terete cece CBA ee eee ONS 224.7 Pk cette eee eee (G2). ...., cercese 202.3 210.6 Blumstrand and Lundman, 1s, Sweidlen (26). 76 munuzygolice twin pairs and KT dizygotic twin pairs obtained from Swedish Twin Registry. I, Monozygutes discordant for smoking: Smokers showed slightly lower levels of cholesterol, triglycerides, and phospholipids than nonsmokers, If. Dizygotes discordant for smoking: Smokers showed significantly higher levels of phospholipids. No differences for cholesterol and triglycerides. The authors conclude from the differing MZ and DZ results that constitutional factors are probably more important than amoking in determining lipid levels. 96 Tape A7.—Differences in serum lipids between smokers and nonsmokers (cont.) {Actual number of individuals shown in parentheses}? {SM = Smukers NS = Nonsmokers} Autbor, year, Number and country, type of Results Commenta reference population Fidanza Vo male prigoners Serum choleaterol mg. percent No statistically algnificant etal, 34-69 years of Ages C39 40-49 50-59 60-69 differences found between 166, ake. NS lisse cseee eee . 195 (12) 189 (10) 176 (7) SM and NS, Traly “LW cigarettes/dsy cic vcse evens 208(8) 201(16) 202(13) 195 (10) (62). D>20 cigarettes/day ....sseeeeeaes 197 (6) 175 (7) 171 (7) Serum triglyceridce mg, percent NS cicaev eee renee $4.7 9 85.0 <20 cigarettes/day 84.6 99.4 101.9 89.8 >20 cigarettes/day 91.0 86.0 65.7 Kedra and 200 clinically Serum cholesterol Phospholiptda Total lipida Serum cholesterol also noted Dmowski, henlthy males mg. percent mg. pereent mg. percent to increase with increasing 1966, 20-50 years of NS(100) ....... eee 170.2 268.1 1,234.8 intensity and duration of Poland ue. SM 100) vscsevevees ze} POOL asa.ge P7006 vasa} PSO0L smoking. (9s), Heta-lpoproteins Total futty acids percent of total mg, percent tipoprotcine NS(100) ..cceee eves YTS 43.1 SM 100) .eccese eee woof PSO. wat p 10 cigarettes/day 240.0 (166) 180.0 £6 TaBLe A7.—Differences in serum lipids between smokers and nonsmokers (cont.) (Actual number of individuals shown in parentheses)?! {SM = Smckers NS = Nonsmokers) Author, year, Number and country, type of Results Comments reference population Higgins 5,030 male und Males Females and Kjelsterg, fomale residents NS icc ee cere renee 209.9 (360) 210.1 (1,439) 1967, uf Tecumsch, Cigorette .i.cseuee Se ceec cere ev cveeeneeee 212,602,426) 212.4 (910) U.S.A, Michigan, 16-79 (8d), years of age. Pincherly 2,000 men Percentage with serum = The authors noted that amokers and Wright, participating in Serum cholesterol cholesterol >270 showed significantly bigher 1967, executive health mg, percent mg. percent {p<0,001) aerum cholesterol England examinations NS (677) 236.2 19.0 levels than nonsmokers, (150). 28-70 years of Ex-smoker (388) ...-....0-.55 oe 246.0 28.0 age. 1-19 cigarettes/day (424) oo. cc cee eee ee 239.2 24.0 >20 cigarettes/day (SLL)... cece eee eee 249.4 30.0 Van Buchem, 918 randomly chosen Serum cholesterol The authors found no 1967, males 40-5Y yoars 0-209 mg, percent 210-249 mg. percent 3250 mg, percent correlation between smoking Netherlands of age for entry NS icseccecceveecevecee 22.4 (32) 14.0 (44) 14.2 (41) and serum cholesterol levels. (199), into prospective CigaretteSM ......... 71.6 (184) 67,.8(213) 68.2(197) study. Other wecseweeee 16.0 (41) 18.2 (67) 17.6 (61) Buyle et al. 1,104 male factory Serum cholestera Scrum Beta-lipoprotein Beta-lipoproteina were found 1968, . employees 20-64 mg. percent mg. percent to inerease with age, but U.S.A. yenrs of age. NS ccs ec ceca ee cece neers veces 243(519) 0.925 smokers had higher levels P28), SM cece eect e ne asi tste) f b<0.005 asi} P<0.001 than nonsmokers at all ages. Caganova 49 males living Serum cholesteral Serum Beta-lipoprotein etal, in youth hostel, mg. percent mg. percent 1968, 21.6 average axe, NS(34) cee eae e eee Devens 188.20 359.80 Czechoslovakia SM (15) cece ccvcc een eunceseauns 214.20) ¥<0.025 1a2toy P<0.001 (36). Beta/alpha lipoprotein ratio NS(94) .... oe ‘ SM (15) 86 TABLE A7.—Differences in serum lipids between smokers and nonsmokera (cont.) (Actual number of individuals shown in parentheses)! {SM = Smokers NS = Nonemokers] Author, year, Number and country, type of Resulta Comments refcrence population Modzclewskt 140 males 20-68 Serum-cholesterol Serum Seta-lipoproteine Serwm free fatty acids and Malee, years of age, NS (20) p<0.01 NS p<0.01 NS pool 196, Heavy amokers Heavy umukers lleavy smokers Poland | (28), Kjeldsen, 934 employees of Serum choleaterol mg. percent 1969, various firms NS (196) 236 Denmark in Copenhagen, SM (738) 2a P<0.01 (413). Potner 4 male and Scrum cholesterol Serum triglycerides Total Phospholipide Significant figures refer to and Billimoria, female healthy : | mg. percent mg. pereent mg. percent heavy smokers as compared 1970, volunteers 19-30 NS(20) wc... cc ceee) 196.3 68.6 193.4 with nonsmokers. England years of age. Light SM(17)0...., 0 1721 68.4 188.9 (151). ver 7.3 iGlgarettes/day) Heavy SM(27) «2... 200.0 pc0.06 87.6 p>0.05 215.0 p<0.001 (Over 22.5 1Uniess otherwise specifi and the eum of the indiv} of elther occasional, cigarettes/day) ed, disparities between the total number of cases dual smoking categories are due to the exclusion miscellaneous, mixed, or ex-amokers, 66 TABLE A8.—Blood pressure differences between smokers and nonsmokers (Actual number of individuals ahown in parentheses)? (SM = Smokers NS = Nonsmokers) Author, year, countty, Number and type Results Commenta reference of population Dawber etal., 1,253 male Systolic blood preasure No association found 1969, U.S.A, and female Agee 29-44 45-59 between aystolic blood (47). residents NS(19) ec ce cee et eee eeee renee nnre weseee 138.8 143.0 pressure and amoking, of Framingham. Cigarettes(874)) wo... : . vee 182.5 140.3 S1LOCTE) vce ce cee ee 194.2 144.0 10-19(434) ........, 129.4 141.6 20~39(651) oe eee ee 132.2 138.9 PAOCIMA) oseee eee ee ve 136.1 141.6 Pipe and cigar (128) 135.0 141.9 Edwarda et al., 1,737 male Proportion of males with “Hypertension” (2200/2100 mm, Hg.) 1969, England patients of NS woes. 27.2 percent (161) (86). general prac- Cigarettes 20.5 percent (780) titioners over Pipe ieee e ccc ecce en neueeves 23.9 percent (341) 60 years of age, Karvonen et a}., 625 males in Systolic blood pressure No duta on pipe and 1959, Finland various regions Weat Finland Laat Finland Helainks cigar smokers, No (97), of Finland NS .,, 139.2 (64) 142.6 (39) 132.8 (62) statistical significance 20-59 years of SM . 133,2(91) 135.4 (103) 129,8(166) noted. age. Diastolic blood pressure NS sees 84,7 86.8 89.6 81.9 84d 86.8 Clark et al., 1,859 male civil Mean syatolic Mean diastolic Nonsmoker and smoker 1967, U.S.A. servants, blood-preagure blood-pressure groups were of similar (43). NS (728) © 137.0 83.9 average age, SM (407) iat (p=0.05) east (p350.06) OoT TABLE A8.—Blood pressure differences between smokers and nonsmokers (cont.) (Actual number of individuals shown in parentheses)? (SM = Smokers NS = Nonsmokers)} Author; year, country, Namber and type ' Results Comments reference of population Higgine and 5,030 male and Age adjusted Age adjusted Kjelsburg, female residents mean eyatotic blood pressure mean diastolic blood preasure 1967, U.S.A. of Tecumseh, Michigan, Males Females Males Females (a3), 16-79 years of age, NS ........187.8 (360) 84.5 (1439) 186.6 (960) 82,1(1439) (p<0.001) Clemrette 2960411426) 81.4 (810) 131.6 (1426) 79.0 (910) pe. Reid et al., 676 male British Mean eyatolic blood preasure The author did note 1967, England and 625 male (adjusted for difference in weight) AMcan diastolic blood pressurc SM-NS blood presaure dif. (155), American postal UK ULS.A. UK U.S.A, ferences prior to workers 40-59 NS .......128.2 (45) 124.8 (80) 79,3 81.0 controfling for weight, years of age. 1-14 gramg 130.2 (27) 183.0 (60) 79.4 82.1 but not after auch control. 16-24 grams 128.6 (232) 127.7 (169) 78.6 11.3 >25 grams 127.9 (70) 128.1 (218) 17.6 WA All amounts 129.1 (519) 128.6 (447) 78.7 78 Tibblin, 1967, 895 males in Blood pressure 215-145/ 150-170/ Numbers in parenthcses Sweden Goteborg, Sweden, 110/370 (89) 75-95 (468) 100—110(220) > 175/>115(78) represent total in blood (187), bor in 1913, NS wee ee cece eae see TBO 23.0 25.5 34.7 pressure group. I-14 cigarettes ...........29.2 29.2 25.5 18.7 The author noted >16 cigarettes .......,...28.1 20.9 15.5 17.3 a stepwive decrease with Pipeandcigar .,.......,,11.2 86 10.0 4.0 level of blood pressure _ As smoking increased. ‘Unless otherwise specified, disparities between the total number of in- dividuals and the aum of the individual smoking categories are due to the exclusion of either occasional, miscellaneous, mixed, or ex-smokera.