• Center on Health Equity and Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

Cigarette Smoking Doubles Risk of Heart Failure, Study Finds


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.”


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

Related Videos
Ruben A. Mesa, MD, president and executive director of Atrium Health Levine Cancer Institute and Atrium Health Wake Forest Baptist Comprehensive Cancer Center
Related Content
© 2023 MJH Life Sciences
All rights reserved.