The impact of smoking on thromboembolism and mortality in patients with incident atrial fibrillation: insights from the Danish Diet, Cancer and Health study

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Abstract

ABSTRACT BACKGROUND Smoking and atrial fibrillation (AF) are major health problems world wide and responsible for substantial health-care costs. Our aim was to investigate whether smoking impacts on the risk of stroke and death in patients with AF. To test this hypothesis, we analysed data from a large Danish cohort, the Diet, Cancer and Health study. METHODS A cohort study of 57,053 persons (27,178 men, 29,876 women) aged 50 to 64. The risk of thromboembolism (ischemic stroke/arterial thromboembolism) or death according to smoking habits amongst 3,161 patients with incident AF (mean age 66.9 years; 2,032 men, 1,129 women) was assessed using Cox proportional hazard models after a median follow-up of 4.9 years. RESULTS Of those with AF, 34% were current and 37% former smokers. After adjustment for vitamin K antagonist treatment the hazard ratios (HR) (95% CI) of thromboembolism or death were 3.13 (1.72-6.37) and 2.73 (2.02-3.70) among heavy current female and male smokers (>25 grams/day), respectively. The associations remained even after adjustment for well-established risk factors with HRs of 3.64 (1.88-7.07) and 2.17 (1.59-2.95) among women and men, respectively. In a sensitivity analysis, smoking was still strongly associated with thromboembolism or death after censoring people with a cancer diagnosis during follow-up. CONCLUSIONS Smoking is associated with a higher risk of thromboembolism or death in patients with AF even after adjusting for well-recognised risk factors used in stroke risk stratification schemes. The associations may be modified by sex, as the associations were strongest among women.
Original languageEnglish
JournalChest
Volume145
Issue number3
Pages (from-to)559-566
Number of pages8
ISSN0012-3692
DOIs
Publication statusPublished - 2014

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