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Smoking increases risk for HF hospitalization, CV death in HFpEF
Among patients with HF with preserved ejection fraction, current smoking may be associated with increased risk for hospitalization for HF and CV death compared with former or never smokers, according to a study published in The American Journal of Cardiology.
“Although the influence of cigarette smoking on death in HFpEF is clear, the relation between smoking and heart-failure specific outcomes, such as hospitalization for heart failure, has not been specifically examined in patients with HFpEF,” Pratik B. Sandesara, MD, of the division of cardiology in the department of medicine at Emory University School of Medicine, and colleagues wrote. “Because HFpEF accounts for over 50% of all heart failure cases, a better understanding of the relation between smoking and HFpEF is needed, as smoking possibly represents an important modifiable risk factor to improve outcomes in this subset of patients with heart failure.”
To investigate the association between smoking practices and HF-specific outcomes in patients with HFpEF, researchers included 1,717 adults (mean age, 71 years; 50% men; 78% white) from the TOPCAT trial.
Participants were then classified as being a current (7%), former (51%) or never (42%) smoker.
Researchers used multivariable Cox regression to examine risk for hospitalization for HF, death and CV death across the three smoking categories.
Patients were followed up for a median of 2.9 years. During this time, there were 387 hospitalizations for HF, 374 deaths and 218 CV deaths.
After adjusting for CV risk factors, the researchers found that current smoking was associated with elevated risk for HF hospitalization (HR for former vs. never = 1.25; 95% CI, 0.99-1.57; HR for current vs. never = 1.68; 95% CI, 1.08-2.61), death (HR for former vs. never = 1.02; 95% CI, 0.81-1.29; HR for current vs. never = 1.82; 95% CI, 1.19-2.78) and CV death (HR for former vs. never = 1; 95% CI, 0.74-1.35; HR for current vs. never = 1.85; 95% CI, 1.09-3.24).
When the researchers limited the analysis to those with a history of smoking, they found that current smoking was associated with elevated risk for HF hospitalization (HR for current vs. former = 1.54; 95% CI, 1.01-2.36), death (HR for current vs. former = 1.81; 95% CI, 1.19-2.75) and CV death (HR for current vs. former = 1.76; 95% CI, 1.04-2.98) compared with former smokers.
“Cigarette smoking has important implications for the practicing physician, as it has repeatedly been linked to serious comorbidities and a higher risk of death across multiple medical conditions,” the researchers wrote. “With the increasing prevalence of HFpEF, and a lack of effective disease-modifying therapies, smoking cessation possibly represents an important component of HFpEF management to reduce morbidity and mortality in this high-risk group. Additionally, smoking cessation may have a role to reduce hospitalization for acute decompensated heart failure. However, current guidelines do not specifically emphasize smoking cessation in the management of HFpEF.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.