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J Cardiol. 2015 May;65(5):429-33. doi: 10.1016/j.jjcc.2014.07.012. Epub 2014 Aug 13.

Impact of persistent smoking on long-term outcomes in patients with nonvalvular atrial fibrillation.

Author information

1
Center for Health Care and Human Sciences, University of Toyama, Toyama, Japan.
2
Second Department of Internal Medicine, University of Toyama, Toyama, Japan. Electronic address: thirai@med.u-toyama.ac.jp.
3
Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
4
Department of Neurology, University of Toyama, Toyama, Japan.

Abstract

BACKGROUND:

Although smoking is a risk factor for cardiovascular diseases, little is known about the impact of smoking on long-term outcomes in patients with atrial fibrillation (AF).

METHODS:

In 426 consecutive patients with nonvalvular AF (mean age, 66 years; 307 men; mean follow-up, 5.8±3.2 years), clinical variables including smoking status, CHADS2, and CHA2DS2-VASc score, incidences of cardiovascular events (stroke, myocardial infarction, or admission for heart failure), bleeding, and mortality were determined.

RESULTS:

Incidences of intracranial bleeding (0.7% vs 0.1%/year, p<0.01), all-cause mortality (4.9% vs 2.6%/year, p<0.01), and death from stroke (0.8% vs 0.2%/year, p<0.05) were higher in patients with history of smoking than in those without it. Incidence of intracranial bleeding was significantly higher in persistent smokers than in non-persistent smokers (1.2% vs 0.2%/year, p<0.01). History of smoking predicted all-cause mortality [hazard ratio (HR), 2.7; 95% confidence interval (CI), 1.7-4.5; p<0.01] and death from stroke (HR 4.7; 95% CI 1.0-22.3; p<0.05) independent of age, antithrombotic treatment, CHADS2, and CHA2DS2-VASc score. Persistent smoking predicted intracranial bleeding (HR 4.4; 95% CI 1.1-17.6; p<0.05) independent of age and antithrombotic treatment.

CONCLUSIONS:

Smoking status, independent of age, antithrombotic treatment, and clinical risk factors, predicted long-term adverse outcomes including bleeding events in patients with nonvalvular AF. There might be an obvious impact of persistent smoking on intracranial bleeding.

KEYWORDS:

Nonvalvular atrial fibrillation; Prognosis; Smoking

PMID:
25129639
DOI:
10.1016/j.jjcc.2014.07.012
[Indexed for MEDLINE]
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