A STARK warning has emerged as new evidence shows that smoking, even at very low levels, significantly increases long-term cardiovascular risks. The study reveals that individuals who engage in low intensity smoking still face elevated dangers of heart attack, heart failure, and death.
Shifting Tobacco Habits and Hidden Dangers of Smoking
As smoking patterns change globally, with fewer people consuming full packs each day, researchers emphasize that low intensity smoking is far from safe. The study highlights that even adults who smoke only two to five cigarettes daily may still carry a significantly increased risk compared with people who never smoked.
Extensive Multi Cohort Analysis Reveals Clear Risk Patterns in Smoking
Researchers examined data from 323,826 adults across 22 longitudinal studies with follow up reaching 19.9 years. Over this period, investigators documented more than 125,000 deaths and 54,000 cardiovascular events, including myocardial infarction, stroke, coronary heart disease and heart failure. Median follow up ranged from 14.4 years for myocardial infarction to approximately 19.4 to 19.9 years for mortality outcomes.
Compared with never smokers, current smokers showed increased risks for cardiovascular disease with hazard ratios of 1.74 in men and 2.07 in women, and all-cause mortality with hazard ratios of 2.17 in men and 2.43 in women. Notably, those smoking just 2 to 5 cigarettes per day demonstrated hazard ratios ranging from 1.26 for atrial fibrillation to 1.57 for heart failure. Smoking 2 to 5 cigarettes per day was also linked to higher cardiovascular mortality at a hazard ratio of 1.57 and all-cause mortality at a hazard ratio of 1.60. The highest risk reduction occurred in the first decade after quitting smoking, with reductions continuing for decades thereafter.
Implications For Clinical Prevention and Future Research
Clinicians should encourage complete cessation rather than reduced consumption, as stopping smoking entirely delivers the most powerful and rapid health benefits. Although risks decline steeply within ten years of quitting, former smokers may retain elevated risk for up to three decades, underscoring the need for long term cardiovascular monitoring. Future research should examine patterns involving e-cigarettes and combined product use to refine prevention strategies and better support patients aiming for full cessation.
Reference
Tasdighi E et al. Association between Cigarette smoking intensity, pack years, and cessation duration with long-term incidence of nine cardiovascular and mortality outcomes: The Cross-Cohort Collaboration (CCC). PLOS Aging and Health. 2025;DOI:10.1371/journal.pmed.1004561.
