Cigarette Smoking and Incident Heart Failure: Insights From the Jackson Heart Study

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d768603e306">Background:</h5> <p id="P1">Cigarette smoking has been linked with several factors associated with cardiac dysfunction. We hypothesized that cigarette smoking is associated with left ventricular (LV) structure, function and incident heart failure (HF) hospitalization. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d768603e311">Methods:</h5> <p id="P2">We investigated 4129 (never smoker n=2884, current smoker n=503, and former smoker n=742) African American participants (mean age 54 years, 63% women) without a history of HF or coronary heart disease (CHD) at baseline in the Jackson Heart Study. We examined the relationship between cigarette smoking and LV structure and function using cardiac magnetic resonance imaging (CMR) among 1092 participants, cigarette smoking and brain natriuretic peptide (BNP) levels among 3325 participants and incident HF hospitalization among 3633 participants with complete data. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d768603e316">Results:</h5> <p id="P3">After adjustment for confounding factors, current smoking was associated with higher mean LV mass index and lower mean LV circumferential strain ( <i>P</i> &lt;0.05, for all) compared with never smoking. Smoking status, intensity and burden were associated with higher mean BNP levels (all <i>P</i> &lt;0.05). Over 8.0 years (7.7–8.0) median follow-up, there were 147 incident HF hospitalizations. After adjustment for traditional risk factors and incident CHD, current smoking (HR 2.82, 95%CI 1.71~4.64), smoking intensity among current smokers (≥20 cigarettes/day: HR 3.48, 95%CI 1.65~7.32) and smoking burden among ever smokers (≥15 pack-years: HR 2.06 95%CI 1.29~3.3) were significantly associated with incident HF hospitalization compared with never smoking. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d768603e327">Conclusions:</h5> <p id="P4">In African Americans, cigarette smoking is an important risk factor for LV hypertrophy, systolic dysfunction and incident HF hospitalization even after adjusting for effects on CHD. </p> </div>