Expired-air carbon monoxide as a predictor of 16-year risk of all-cause, cardiovascular and cancer mortality
Introduction
Expired-air carbon monoxide (EACO) measurement is a simple and cheap method commonly used to ascertain non-smoking status in ex-smokers. However EACO is not only a marker of smoking, it also reflects inhaled ambient carbon monoxide (CO) and endogenous production of CO related to vasoactive, oxidative and inflammatory processes (Durante, 2002, Owens, 2010). Although the health effects of smoking and acute carbon monoxide intoxication are well known, EACO has not been studied so far as a potential predictor of long-term mortality.
The aim of this study was to assess the 16-year risk of all-cause, cardiovascular and cancer mortality according to EACO levels measured at baseline, in a sample selected from the general population.
Section snippets
Study population and design
The study design comprised one single baseline (1994–1997) interview of the participants and one single baseline measurement of EACO and biomarkers. An administrative follow-up was then organized to record vital status of all participants until December 31, 2011. A sample of 3402 subjects was randomly recruited from the general population to participate in the Third French MONICA Cross-Sectional Survey on the prevalence of cardiovascular risk factors (Kuulasmaa et al., 2000, Marques-Vidal et
Results
Table 1 describes and compares the main characteristics of study participants according to tertiles of EACO. EACO was measured in 2232 participants (n = 973 from northern France (Lille), n = 269 from north-eastern (Strasbourg area) and n = 990 from south-western France (Toulouse area)) equally distributed by gender. Mean age was 50 years (± 8 years). At baseline, 46% of participants had never smoked, 27% were former and 27% were current smokers. Mean EACO was 11.8 (± 7.4), 4.6 (± 2.5) and 4.3 (± 2.2) ppm
Discussion
In this study carried out in apparently healthy people recruited from the general population, we showed that, after adjustment for standard risk factors and smoking, baseline EACO is an independent predictor for 16-year all-cause and cancer mortality. Moreover, EACO measurement enhances the performance of the models predicting all-cause and cancer mortality, which suggests that EACO could participate in the mechanisms increasing the risk of all-cause and cancer mortality. On the other hand,
Conclusion
In conclusion, in a general population, after adjustment for confounders including smoking, baseline EACO level is an independent predictor of 16-year all-cause and cancer mortality. Smoking remains a better predictor of CV mortality than EACO. Besides, our results highlight that levels of EACO are not solely related to smoking exposure, but can also reflect ambient carbon monoxide exposure as well as endogenous productions in response to vasoactive, oxidative or inflammatory processes.
Sources of Funding
This work was supported by the " Institut National de la Santé et de la Recherche Médicale" (INSERM), the "Direction Générale de la Santé (DGS)"; the "Institut Pasteur de Lille", the "University Hospital of Lille"; the "Fonds d'intervention en Santé Publique"; the "Mutuelle Générale de l'Education Nationale"; "ONIVINS"; the "Fondation de France"; the "CPAM of Sélestat"; the "Fédération Française de Cardiologie" the "Conseil Régional du Nord-Pas de Calais"; Parke-Davis and Bayer pharmaceuticals;
Conflict of interest statement
The authors declare that they have no conflict of interest
Acknowledgments
We would like to thank all the investigators of the MONICA Project for their contribution to the compilation and validation of the data. We did appreciate the collaboration with the INSEE and the health centers in the 3 regions.
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