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Smoking as a Risk Factor for Cardiovascular Disease in Females and Males: Observational and Mendelian Randomisation Analyses in the UK Biobank Cover

Smoking as a Risk Factor for Cardiovascular Disease in Females and Males: Observational and Mendelian Randomisation Analyses in the UK Biobank

Open Access
|Oct 2025

Figures & Tables

Table 1

Characteristics of study population in observational analysis.

CHARACTERISTICSNO. OF NON-MISSING VALUES IN FEMALESFEMALES (n = 261,920)NO. OF NON-MISSING VALUES IN MALESMALES (n = 206,918)
Age, years261,92056.1 (8.0)206,91856.2 (8.2)
Ethnicity260,714205,570
      White246,775 (94.2)194,382 (93.9)
      Other*13,909 (5.3)111,70 (5.4)
Smoking status260,514205,697
      Never smoker156,428 (59.7)103,982 (50.3)
      Former smoker81,109 (31.0)76,082 (36.8)
      Current smoker22,977 (8.8)25,633 (12.4)
Number of cigarettes smoked daily in current smokers17,30915 [10, 20]15,71015 [10, 20]
Cigarettes smoked per day in current or former smokers68,73065,131
      1–56,421 (2.5)3,420 (1.7)
      6–1532,463 (12.4)24,593 (11.9)
      16–2524,527 (9.4)28,310 (13.7)
      26–353,542 (1.4)6,605 (3.2)
      ≥361,797 (0.7)5,633 (2.7)
Socioeconomic status261,606206,649
      Townsend deprivation index score–2.17 [–3.6, 0.4]–2.17 [–3.7, 0.5]
      Townsend deprivation thirds
            Low (≥1.40)49,097 (18.7)40,676 (19.7)
            Middle (≥–2.08 – <1.40)78,601 (30.0)60,374 (29.2)
            High (<–2.08)133,908 (51.1)105,599 (51.0)
Outcomes (first occurrence after study entry)
      Cardiovascular disease19,076 (7.3)28,768 (13.9)
        Coronary heart disease14,450 (5.5)23,458 (11.3)
          Myocardial infarction3,192 (1.2)6,820 (3.3)
        Stroke4,626 (1.8)5,310 (2.6)
          Ischaemic stroke3,392 (1.3)4,388 (2.1)
          Intracerebral haemorrhage709 (0.3)664 (0.3)
          Subarachnoid haemorrhage525 (0.2)258 (0.1)

[i] Numbers are presented as mean (standard deviation), median [25th, 75th percentile], or number (percentage). *Includes Asian or Asian British, Indian, Pakistani, Bangladeshi, any other Asian background, Chinese, black or black British, Caribbean, African, any other black background, other ethnic group, white and black Caribbean, white and black African, white and Asian, and any other mixed background.

Figure 1

Cox regression and Mendelian randomisation analysis of the association between ever smoking and risk of cardiovascular events in females, males, and the overall population.

MR estimates are from inverse-variance weighted MR, and ORs can be interpreted as the effect per unit increase in log odds of genetic liability to ever smoking. MR analyses were performed in 337,386 UK Biobank participants. Cox regressions were performed in 468,838 UK Biobank participants and were adjusted for sex and Townsend deprivation index (an area-based measure of socioeconomic status), including an interaction term between Townsend deprivation index and sex. CI, confidence interval; HR, hazard ratio; MR, Mendelian randomisation; OR, odds ratio; RHR, ratio of hazard ratios; ROR, ratio of odds ratios.

Figure 2

Cox regression and Mendelian randomisation analysis of the association between smoking continuation and risk of cardiovascular events in females, males, and the overall population.

MR estimates are from inverse-variance weighted MR, and ORs can be interpreted as the effect per unit increase genetic liability to smoking continuation among ever smokers. MR analyses were performed in 337,386 UK Biobank participants. Cox regressions were performed in 468,838 UK Biobank participants and were adjusted for sex and Townsend deprivation index (an area-based measure of socioeconomic status), including an interaction term between Townsend deprivation index and sex. CI, confidence interval; HR, hazard ratio; MR, Mendelian randomisation; OR, odds ratio; RHR, ratio of hazard ratios; ROR, ratio of odds ratios.

Figure 3

Cox regression and Mendelian randomisation analysis of the association between the number of cigarettes smoked per day and risk of cardiovascular events in females, males, and the overall population.

The variable representing the number of cigarettes smoked per day was categorised into the following categories: 1 = 1–5, 2 = 6–15, 3 = 16–25, 4 = 26–35, 5 = 36+ and was analysed as a continuous variable. MR estimates are from inverse-variance weighted MR, and ORs can be interpreted as the effect per category increase of genetically proxied number of cigarettes smoked per day among ever smokers. MR analyses were performed in 337,386 UK Biobank participants. Cox regressions were performed in 468,838 UK Biobank participants and were adjusted for sex and Townsend deprivation index (an area-based measure of socioeconomic status), including an interaction term between Townsend deprivation index and sex. CI, confidence interval; HR, hazard ratio; MR, Mendelian randomisation; OR, odds ratio; RHR, ratio of hazard ratios; ROR, ratio of odds ratios.

DOI: https://doi.org/10.5334/gh.1485 | Journal eISSN: 2211-8179
Language: English
Submitted on: Feb 3, 2025
Accepted on: Sep 26, 2025
Published on: Oct 13, 2025
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 Sophie C. de Ruiter, Lena Tschiderer, Diederick E. Grobbee, Patrick Rockenschaub, Ynte M. Ruigrok, Peter Willeit, Hester M. den Ruijter, A. Floriaan Schmidt, Sanne A. E. Peters, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.