Study: Smoking doubles the risk of developing heart failure

A new study by researchers at the Johns Hopkins Bloomberg School of Public Health[1] found that people who smoked cigarettes were twice as likely to develop heart failure as those who never smoked. This risk was present for both subtypes of heart failure (heart failure with reduced ejection fraction and heart failure with preserved ejection fraction).[2].

Heart failure is a progressive disease in which the heart loses its ability to pump enough blood to meet the body's needs. It is one of the most common causes of disability and death in developed countries, with more than 6 million adults suffering from heart failure in the United States alone, according to the most recent data from the Centers for Disease Control and Prevention.

The researchers evaluated the medical records of participants in the Atherosclerosis Risk In Communities (ARIC) study. Launched in 1987, the ARIC study includes middle-aged and older adults across the United States, with a significant representation of African Americans. The new study's analysis includes data from four communities in Maryland, North Carolina, Minnesota, and Mississippi, and includes 9,345 participants, ages 61 to 81, who had not been diagnosed with heart failure as of early 2005.

Twice the risk for smokers

Over a median follow-up of 13 years, the study identified 1,215 cases of heart failure, including 492 cases of reduced ejection fraction and 555 cases of preserved ejection fraction. The researchers' analysis showed that smokers in the group were diagnosed with both subtypes of heart failure at elevated rates compared to nonsmokers and at roughly the same levels—2.28 times higher for heart failure with preserved ejection fraction and 2.16 times higher for heart failure with reduced ejection fraction.

A risk that persists long after quitting smoking

The association with smoking also showed a dose-response relationship—more cigarettes per day and more years of smoking were associated with a higher risk of heart failure. Similarly, quitting smoking led to a lower risk of heart failure that increased over time. Overall, former smokers were 31% and 36% more likely to have heart failure with preserved ejection fraction and heart failure with reduced ejection fraction, respectively, compared to never smokers.

When the researchers stratified former smokers by the number of years since quitting, they found that their overall risk of heart failure remained significantly higher than that of never smokers—except for the group who hadn't smoked for 30 years or more.

Keywords: heart failure, smoking, United States, heart disease, smoking cessation

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