‘Dealing with a time bomb’: Persistent tobacco smoking tied to cardiac injury at young age
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Key takeaways:
- Tobacco smoking from childhood to young adulthood was linked to significant cardiac damage by age 24 years.
- More than half of children that started smoking from age 10 continued smoking until age 24 years.
In a cohort of English youths, those who persisted smoking tobacco from childhood to early adulthood showed significant cardiac damage by age 24 years and potentially irreversible cardiac injury, a researcher reported.
Andrew Agbaje, MD, MPH, PhD, associate professor of clinical epidemiology and child health at the University of Eastern Finland in Kuopio, Finland, analyzed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, a study designed to assess factors tied to childhood development and growth in England, to better understand the impact of persistent smoking from a young age on cardiac function and potential damage. The results were published in the Journal of the American College of Cardiology.
“Tobacco smoking is bad. It’s a risk factor for cancers and heart disease, but the population that has been studied, where we get the outcomes from, are an adult population. In between when a child or an adolescent picks up smoking, many things have happened before the age of 45, but we have limited idea what those things are,” Agbaje told Healio. “We presume that something is happening and just say, ‘heart attack happens because of smoking.’ When I saw that knowledge gap, I felt it is better to understand what happens during the phase of growth before a heart attack.
“If we say that smoking from adolescence results in cardiac damage in middle age, it may give some people the liberty to keep on smoking. But if they know that heart damage had already begun 20 years earlier, then that worries them,” Agbaje said. “They don’t look at it as 40 more years to keep on smoking, but acknowledge the likelihood of immediate heart injury that may not be reversible. Then they err toward caution.”
Prevalence of childhood smoking
Overall, 1,931 ALSPAC participants had echocardiographic measures at age 24 years, of which 890 had echocardiograms at age 17 years and 24 years (mean age at baseline, 10.6 years; 63% female). A questionnaire was used to determine smoking status during follow-up at age 10, 13, 15, 17 and 24 years, with the question “if participants had smoked tobacco cigarettes in the last 30 days.”
The prevalence of smoking was 0.3% at age 10 years; 1.6% at age 13 years; 13.6% at age 15 years; 24% at age 17 years; and 26.4% among those aged 24 years. Overall, 60% of participants who initiated smoking at ages 10, 13, 15 or 17 years persisted in smoking at age 24 years, according to the study.
“We have a critical time point to intervene in picking up a smoking habit, and that is between the age of 13 and 17 years,” Agbaje told Healio. “The teenage years are a period for us to put a break on how fast children or young adolescents pick up smoking because the prevalence increased from about 1.6% to 24% within a span of 4 years. That is a jet speed in picking up a smoking habit.
“This is where the profit from the tobacco companies is coming from because once they get that cigarette in your mouth, 60% of people who started it will remain customer for several decades,” Agbaje said. “We need to find a way to unhook children and adolescents because otherwise we are losing a generation.”
Smoking in youth and premature cardiac injury
After adjusting for age, sex, high-sensitivity C-reactive protein, heart rate, systolic BP, fasting insulin and glucose, family history of CV risk factors, socioeconomic status, physical activity, lipids, fat mass and lean mass, by age 24 years, persistent smoking from childhood was associated with increased odds of:
- Left ventricular hypertrophy (OR = 1.52; 95% CI, 1.39-1.66; P < .001);
- high relative wall thickness (OR = 1.38; 95% CI, 1.26-1.51; P < .001);
- LV diastolic dysfunction (OR = 1.33; 95% CI, 1.22-1.46; P < .001); and
- high LV filling pressure (OR = 1.35; 95% CI, 1.25-1.45; P < .001).
“We are dealing with a time bomb. We do not need to wait until age 45 years to see the first heart attack, or HF [in this young generation] ... Something has been going wrong for at least 20 years, but none of us seem to pay serious attention,” Agbaje told Healio. “When heart failure has occurred, we are not preventing anything anymore, simply managing symptoms or decreasing the likelihood of relapse. We need to primordially and primarily prevent heart diseases.
“As a public health message, our governments need to be bold in addressing this fundamental tobacco/nicotine problem because heart disease is highly preventable if we can take care of some of these risk factors,” Agbaje said. “We understand that taxes appear to generate some revenue. But we have also seen evidence that the health care cost of treating tobacco-related diseases is two times higher than the profit generated from tobacco. So we are paying for what is killing our children. We need to save the upcoming generation. The future of every nation is the children of today. If they die before we die, what happens to our nation? Tobacco/nicotine product is the dilemma of the century, please let’s save the kids.”
Reference:
- Smoking tobacco from childhood can cause premature heart damage. https://www.eurekalert.org/news-releases/1067618. Published Dec. 11, 2024. Accessed Dec. 11, 2024.
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