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Secondhand smoke exposure in utero, during childhood increased future AF risk
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Participants in a cross-sectional analysis who reported exposure to secondhand smoke during gestation or childhood showed a significantly higher risk for developing atrial fibrillation, researchers reported in Heart Rhythm.
The link between AF and secondhand smoke exposure was more pronounced among those who lacked other risk factors for the condition, they wrote.
The study included data from 4,976 participants in the longitudinal, Internet-based Health eHeart Study, which included responses to a 22-question survey about secondhand smoke exposure while in utero and during childhood and adulthood, as well as questionnaires about medical conditions. AF prevalence was identified via participant self-report, and researchers validated the responses of a subset of 42 patients via review of their electronic medical records. Patients who indicated that they had AF received an additional survey about their symptoms, diagnosis and treatment.
Participants reported AF in 11.9% of cases. Of those, 45.7% of participants indicated that they had persistent AF and 46.4% indicated paroxysmal AF. In the validation cohort, 25 participants indicated that they had AF and 17 did not, and electronic medical records confirmed all responses.
Multivariable analysis indicated significant associations between AF and having a parent who smoked during gestation (OR = 1.37; 95% CI, 1.08-1.73) and living with a smoker as a child (OR = 1.4; 95% CI, 1.1-1.79). Both associations were stronger among patients with AF who did not have risk factors for the condition (P < .05 for interaction). Whether the mother or father was the smoker during gestation did not significantly influence results (OR = 1.39; 95% CI, 1-1.74 for the mother; OR = 1.39; 95% CI, 1.09-1.76 for the father).
Assessment of paroxysmal and persistent AF separately indicated that both AF types were significantly associated with secondhand smoke exposure in utero and during childhood. However, after adjustment for confounders, the associations were only significant for persistent AF (OR = 1.43; 95% CI, 1.01-2.01 for in utero exposure and OR = 1.46; 95% CI, 1.02-2.07 for childhood exposure).
The researchers wrote that results from interaction analyses indicated that the association between AF and exposure during gestation and childhood were both stronger in the absence of known risk factors for the condition (P = .021 for gestational and P = .01 for childhood exposure).
“These findings indicate that [secondhand smoke] may be an important, potentially modifiable risk factor for the development of AF, operating outside of known mechanism for arrhythmia,” the researchers concluded. “This research suggests that parental behaviors may be critical in the future development of this disease in offspring. Further research into the mechanism underlying this relationship is needed.” – by Adam Taliercio
Disclosure: One researcher reports receiving research support from Medtronic, NIH, Patient-Centered Outcomes Research Institute, Pfizer and SentreHeart and serving as a consultant for and holding equity in InCarda.
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