Smoking cessation, but not reduction, reduces cardiovascular
The aim of this study was to assess the association of smoking cessation and reduction with risk of cardiovascular disease (CVD).

A total of 897 975 current smokers aged more than 40 years who had undergone two consecutive national health examinations were included. Participants were classified as quitters (20.6%), reducers I (more than 50% reduction, 7.3%), reducers II (20–50% reduction, 11.6%), sustainers (45.7%), and increasers (more than 20% increase, 14.5%). During 5 575 556 person-years (PY) of follow-up, 17 748 stroke (3.2/1000 PY) and 11 271 myocardial infarction (MI) (2.0/1000 PY) events were identified.

Quitters had significantly decreased risk of stroke and MI compared to sustainers after adjustment for demographic factors, comorbidities, and smoking status. The risk of stroke and MI incidence in reducers I and reducers II was not significantly different from the risk in sustainers. Further analysis with a subgroup who underwent a third examination (in 2013) showed that those who quit at the second examination but had starting smoking again by the third examination had 42–69% increased risk of CVD compared to sustained quitters.

Conclusively, smoking cessation, but not reduction, was associated with reduced CVD risk. Our study emphasizes the importance of sustained quitting in terms of CVD risk reduction.