The long-term study also found persistent residual risk of heart failure even after smoking cessation
Cigarette smokers have double the risk of developing heart failure (HF) when compared with nonsmokers, according to a study published in Journal of the American College of Cardiology.
The study from John Hopkins Bloomberg School of Public Health is one of the first to assess smoking’s association with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
Data from the Atherosclerosis Risk In Communities (ARIC) study was used to comprehensively quantify the association of cigarette smoking and smoking cessation with incident of heart failure overall and with HFrEF and HFpEF.
Several established cigarette smoking parameters (smoking status, pack-years, intensity, duration, and years since cessation) were evaluated among 9345 ARIC White and Black participants without history of HF at baseline in 2005. Participant ages ranged from 61 to 81 years.
Over a median follow-up of 13 years, there were 1215 cases of heart failure: 492 cases of HFrEF and 555 cases of HFpEF. Smokers in the group were diagnosed with HFrEF and HFpEF at about the same elevated rates compared with nonsmokers: 2.16 times higher and 2.18 times higher respectively.
For all cigarette smoking measures, there was a robust dose-response relationship with incident acute decompensated HF. Similar associations were found for HFrEF and HFpEF. Those who smoked for ≥ 25 years had approximately double the risk for HF compared with those who never smoked, regardless of demographic or clinical factors.
Additionally, longer duration of smoking cessation was associated with a lower risk of HF.
However, for both HFrEF and HFpEF, excess risk persisted for up to a few decades after smoking cessation. Former smokers were 31% more likely to have HFpEF and 36% more likely to have HFrEF compared with nonsmokers.
Overall, HF risk for former smokers remained significantly higher than those who had never smoked, except for those who had not smoked for 30 years or more.
There was significant dose-response relationships between pack-years and smoking intensity and overall incident HF, supporting findings of previous studies. All smoking parameters showed significant and similar associations with HFrEF and HFpEF.
Some limitations of this study include potential measurement errors in self-reported smoking status and the lack of information on e-cigarettes, which the ARIC study did not collect. The increased prevalence of e-cigarette use warrants further study, authors wrote.
As HFpEF is increasingly recognized as a predominant form of HF and evidence-based treatment for HFpEF is yet to be established, the strong association of smoking and HFpEF indicates the importance of smoking prevention in youth and early smoking cessation among smokers.
Authors of the study suggest that public health efforts and policy makers emphasize the importance of smoking prevention and cessation in relation to the evolving public health issue of HFpEF and the prevention of HF.
“Preventive approaches are crucial for HF, especially for [HFpEF], because HFpEF lacks specific treatment with robust evidence to date,” study senior author Kunihiro Matsushita, MD, PhD, associate professor in the Bloomberg School’s Department of Epidemiology, said in a statement. “We hope our results will encourage current smokers to quit sooner rather than later, since the harm of smoking can last for as many as three decades.”
Reference
Ding N, Shah AM, Blaha MJ, Chang PP, Rosamond WD, Matsushita K. Cigarette smoking, cessation, and risk of heart failure with preserved and reduced ejection fraction. J Am Coll Cardiol. 2022;79(23):2298-2305. doi:10.1016/j.jacc.2022.03.377
Patients With HFrEF, HFpEF See Different Functional Capacity Benefits With Dapagliflozin
December 7th 2023The DETERMINE-Reduced and DETERMINE-Preserved trials demonstrated varying benefits of dapagliflozin on Kansas City Cardiomyopathy Questionnaire Total Symptom Score and Physical Limitation Scale as well as 6-minute walk distance.
Read More
Black Patients With Ulcerative Colitis Less Likely to Undergo IPAA Than White Patients
December 7th 2023Overall, the number of patients discharged from hospitals with an ulcerative colitis diagnosis increased between 2009 and 2018, but the number of patients opting for ileal pouch–anal anastomosis (IPAA) decreased.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Negotiations to extend US global HIV/AIDS relief work are deadlocked; the Biden administration delayed its rule on the proposed menthol cigarette ban until March 2024 after lobbying by civil rights groups; federal agencies have partnered with a digital health company to create an at-home test-to-treat program for flu and COVID-19.
Read More
New Investigation Analyzes Magnetic Resonance Measures of DMD for Disease Progression
December 7th 2023Investigators evaluated longitudinal MRI and spectroscopy outcomes and ambulatory function among 180 patients with Duchenne muscular dystrophy (DMD) to establish the utility and reproducibility of magnetic resonance measures of muscle quality at different disease stages.
Read More