TY - JOUR
T1 - The impact of smoking on thromboembolism and mortality in patients with incident atrial fibrillation
T2 - insights from the Danish Diet, Cancer and Health study
AU - Albertsen, Ida Ehlers
AU - Rasmussen, Lars Hvilsted
AU - Lane, Deirdre
AU - Overvad, Thure Filskov
AU - Skjøth, Flemming
AU - Overvad, Kim
AU - Lip, Gregory Y H
AU - Larsen, Torben Bjerregaard
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
U2 - 10.1378/chest.13-1740
DO - 10.1378/chest.13-1740
M3 - Journal article
C2 - 24091709
SN - 0012-3692
VL - 145
SP - 559
EP - 566
JO - Chest
JF - Chest
IS - 3
ER -