Findings demonstrate a significant association between lifelong smoking status and the risk of major adverse cardiovascular events (MACE).

As the time span increased, health advantages to quitters would become close to that of never smokers, and harms to relapsers and new smokers would become close to that of persistent smokers.

• A total of 5,849 participants from the cohort of the People’s Republic of China-United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology who survived in 1993 to 1994 were included.

• Using the Cox proportional hazards models, the links of lifelong smoking status with MACE in the subsequent 10 years were investigated.

• Development of MACE occurred in 694 participants during a median follow-up of 10.2 years.

• Relative to persistent smokers, the multivariable-adjusted hazard ratio of developing MACE were estimated to be 0.83, 0.75, and 0.68 for short-term quitters, long-term quitters, and never smokers, respectively.

• In comparison, the hazard ratio was estimated to be 1.03 for long-term relapsers and new smokers and 0.78 for short-term relapsers and new smokers.

• These links were not significantly modified by further adjusting for weight alteration in the past 10 years.