Cigarette Smoking and Incident Heart Failure

Study Questions:

Is cigarette smoking associated with left ventricular (LV) dysfunction and incident heart failure (HF)?


Data from the Jackson Heart Study were used for the present analysis. Never smokers were compared to current smokers and former smokers among black participants with no history of HF or coronary heart disease (CHD) at baseline. Smoking status was grouped into never, current, and former. Outcomes of interest included LV structure and function (using cardiac magnetic resonance imaging [MRI]), B-type natriuretic peptide (BNP) levels, and incident HF.


A total of 4,129 participants were included in this study (never smoker: n = 2,884, current smoker: n = 503, and former smoker: n = 742). Mean age was 54 years, and 63% were women. MRI assessment of LV function was completed in 1,092 participants. BNP levels were completed in 3,325 participants, and 3,633 participants had data on HF hospitalizations (yes, no). Current smoking was associated with higher mean LV mass index and lower mean LV circumferential strain (p < 0.05, for both) in comparison with never smoking, after adjustment for confounding factors. Smoking status, intensity, and burden were associated with higher mean BNP. Over 8.0 years of median follow-up, there were 147 incident HF hospitalizations. After adjustment for traditional risk factors and incident CHD, current smoking (hazard ratio [HR], 2.82; 95% confidence interval [CI], 1.71–4.64), smoking intensity among current smokers (≥20 cigarettes/d: 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 in comparison with never smoking.


The authors concluded that among blacks, cigarette smoking is an important risk factor for LV hypertrophy, systolic dysfunction, and incident HF hospitalization even after adjusting for effects on CHD.


These data support the continued importance of reducing smoking rates among Americans, including blacks. Further research is warranted to increase the risk associated with smoking among other ethnic groups.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Magnetic Resonance Imaging, Smoking

Keywords: African Americans, Coronary Artery Disease, Heart Failure, Hypertrophy, Left Ventricular, Magnetic Resonance Imaging, Natriuretic Peptide, Brain, Primary Prevention, Risk Factors, Smoking, Tobacco Products, Ventricular Dysfunction, Left

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