Korean Circ J.  2023 Jan;53(1):17-30. 10.4070/kcj.2022.0179.

The Association of Smoking Status and Clustering of Obesity and Depression on the Risk of Early–Onset Cardiovascular Disease in Young Adults: A Nationwide Cohort Study

• Kim CY
• Lee CM
• Lee S
• Yoo JE
• Lee H
• Park HE
• Han K
• Choi SY

• KMID: 2538100
• DOI: http://doi.org/10.4070/kcj.2022.0179

Abstract

Background and Objectives
To evaluate the impact of smoking in young adults on the risk of cardiovascular disease (CVD) and the clustering effect of behavioral risk factors such as smoking, obesity, and depression.
Methods
A Korean nationwide population-based cohort of a total of 3,280,826 participants aged 20–39 years old who underwent 2 consecutive health examinations were included. They were followed up until the date of CVD (myocardial infarction [MI] or stroke), or December 2018 (median, 6 years).
Results
Current smoking, early age of smoking initiation, and smoking intensity were associated with an increased risk of CVD incidence. Even after quitting smoking, the risk of MI was still high in quitters compared with non-smokers. Cigarette smoking, obesity, and depression were independently associated with a 1.3–1.7 times increased risk of CVD, and clustering of 2 or more of these behavioral risk factors was associated with a 2–3 times increased risk of CVD in young adults.
Conclusions
In young adults, cigarette smoking was associated with the risk of CVD, and the clustering of 2 or more behavioral risk factors showed an additive risk of CVD.

Keyword

Young adult; Cardiovascular diseases; Smoking; Obesity; Depression

Figure

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  Figure 1 Cumulative incidence of CVD, MI, and stroke according to the smoking status (A), change in smoking status (B), and smoking intensity (C).CVD = cardiovascular disease; MI = myocardial infarction.

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  Figure 2 HRs and 95% CIs of CVD, MI, and stroke by clustering of smoking, obesity, and depression. aHRs have been adjusted for age, sex, current smoking, body mass index, depression, drink, regular physical activity, income, hypertension, diabetes mellitus, hypercholesterolemia, and chronic kidney disease.aHR = adjusted hazard ratio; CI = confidence interval; CVD = cardiovascular disease; MI = myocardial infarction; OD = obesity and depression; SD = smoking and depression; SO = smoking and obesity; SOD = smoking, obesity, and depression.

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