Advertisement

Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) Study

      Background

      Cigarette smoking increases the risk of coronary heart disease, but whether smoking increases atrial fibrillation (AF) is uncertain.

      Objective

      The purpose of this study was to determine the association of cigarette smoking with incident AF in a population-based cohort of blacks and whites.

      Methods

      We determined the risk of incident AF through December 2002 in relation to baseline (1987–1989) smoking status and cigarette-years of smoking in over 15,000 participants of the prospective Atherosclerosis Risk in Communities (ARIC) study.

      Results

      Over a mean follow-up of 13.1 years, 876 incident AF events were identified. Compared to never smokers, the multivariable-adjusted hazard ratios (HRs) for AF were 1.32 (95% confidence interval [CI] 1.10–1.57) in former smokers, 2.05 (95% CI 1.71–2.47) in current smokers, and 1.58 (95% CI 1.35–1.85) in ever smokers. In the highest tertile of accumulated smoking amount (>675 cigarette-years), the incidence of AF was 2.10 times greater (95% CI 1.74–2.53) than in those who never smoked. Associations were similar by gender, race, type of event (AF and atrial flutter), and when only AF events identified by study exam ECGs were included. Finally, individuals who quit smoking exhibited a trend indicating a slightly lower risk of developing AF (HR 0.88, 95% CI 0.65–1.17) compared to those who continued to smoke.

      Conclusion

      Smoking was associated with the incidence of AF, with more than a two-fold increased risk of AF attributed to current smoking. In addition, a trend toward a lower incidence of AF appeared among smokers who quit compared to continued smokers.

      Key Words

      Abbreviations:

      AF (atrial fibrillation), ARIC (Atherosclerosis Risk in Communities), BMI (body mass index), CHD (coronary heart disease), CI (confidence interval), ECG (electrocardiogram), HF (heart failure), HR (hazard ratio), ICD (International Classification of Diseases), MI (myocardial infarction)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rosamond W.
        • Flegal K.
        • Furie K.
        • et al.
        Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2008; 17: e25-e146
        • Fuster V.
        • Ryden L.E.
        • Cannom D.S.
        • et al.
        • American College of Cardiology/American Heart Association Task Force on Practice Guidelines. European Society of Cardiology Committee for Practice Guidelines. European Heart Rhythm Association
        Heart Rhythm Society: ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
        Circulation. 2006; 114: e257-e354
        • Chamberlain A.M.
        • Agarwal S.K.
        • Ambrose M.
        • Folsom A.R.
        • Soliman E.Z.
        • Alonso A.
        Metabolic syndrome and incidence of atrial fibrillation among blacks and whites in the Atherosclerosis Risk in Communities (ARIC) Study.
        Am Heart J. 2010; 159: 850-856
        • Chamberlain A.M.
        • Agarwal S.K.
        • Folsom A.R.
        • et al.
        A clinical risk score for atrial fibrillation in a biracial prospective cohort (from the Atherosclerosis Risk in Communities [ARIC] Study).
        Am J Cardiol. 2011; 107: 85-91
        • Benjamin E.J.
        • Levy D.
        • Vaziri S.M.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        Independent risk factors for atrial fibrillation in a population-based cohort.
        JAMA. 1994; 271: 840-844
        • Schnabel R.B.
        • Sullivan L.M.
        • Levy D.
        • et al.
        Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study.
        Lancet. 2009; 373: 739-745
        • Heeringa J.
        • Kors J.A.
        • Hofman A.
        • van Rooij F.J.A.
        • itteman J.C.M.
        Cigarette smoking and risk of atrial fibrillation: the Rotterdam Study.
        Am Heart J. 2008; 156: 1163-1169
        • Krahn A.D.
        • Manfreda J.
        • Tate R.B.
        • Mathewson F.A.
        • Cuddy T.E.
        The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba Follow-Up Study.
        Am J Med. 1995; 98: 476-484
        • Frost L.
        • Hune L.J.
        • Vestergaard P.
        Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study.
        Am J Med. 2005; 118: 489-495
        • Wilhelmsen L.
        • Rosengren A.
        • Lappas G.
        Hospitalizations for atrial fibrillation in the general male population: morbidity and risk factors.
        J Intern Med. 2001; 250: 382-389
        • Yanbaeva D.G.
        • Dentener M.A.
        • Creutzberg E.C.
        • Wesseling G.
        • Wouters E.F.
        Systemic effects of smoking.
        Chest. 2007; 131: 1557-1566
        • Goette A.
        • Lendeckel U.
        • Kuchenbecker A.
        • et al.
        Cigarette smoking induces atrial fibrosis in humans via nicotine.
        Heart. 2007; 93: 1056-1063
        • Ambrose J.A.
        • Barua R.S.
        The pathophysiology of cigarette smoking and cardiovascular disease: an update.
        J Am Coll Cardiol. 2004; 43: 1731-1737
        • The ARIC Investigators
        The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives.
        Am J Epidemiol. 1989; 129: 687-702
        • Soliman E.Z.
        • Prineas R.J.
        • Case L.D.
        • Zhang Z.M.
        • Goff Jr, D.C.
        Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) Study.
        Stroke. 2009; 40: 1204-1211
        • Alonso A.
        • Agarwal S.K.
        • Soliman E.Z.
        • et al.
        Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) Study.
        Am Heart J. 2009; 158: 111-117
        • Baecke J.
        • Burema J.
        • Frijters J.
        A short questionnaire for the measurement of habitual physical activity in epidemiological studies.
        Am J Clin Nutr. 1982; 36: 936-942
        • Eriksson H.
        • Caidaul K.
        • Larsson B.
        • et al.
        Cardiac and pulmonary causes of dyspnea—validation of a scoring test for clinical-epidemiological use: the Study of Men Born in 1913.
        Eur Heart J. 1987; 8: 1007-1014
        • Lin D.Y.
        • Wei L.J.
        The robust inference for the Cox proportional hazards model.
        J Am Stat Assoc. 1989; 84: 1074-1078
        • Benowitz N.L.
        • Jacob P.
        • Jones R.T.
        • Rosenberg J.
        Interindividual variability in the metabolism and cardiovascular effects of nicotine in man.
        J Pharmacol Exp Ther. 1982; 221: 368-372
        • Haass M.
        • Kubler W.
        Nicotine and sympathetic neurotransmission.
        Cardiovasc Drugs Ther. 1997; 10: 657-665
        • Wang H.
        • Shi H.
        • Zhang L.
        • et al.
        Nicotine is a potent blocker of the cardiac A-type K+ channels: effects on cloned Kv4.3 channels and native transient outward current.
        Circulation. 2000; 102: 1165-1171
        • Goette A.
        Nicotine, atrial fibrosis, and atrial fibrillation: do microRNAs help to clear the smoke?.
        Cardiovasc Res. 2009; 83: 421-422
        • Shan H.
        • Zhang Y.
        • Lu Y.
        • et al.
        Downregulation of miR-133 and miR-590 contributes to nicotine-induced atrial remodelling in canines.
        Cardiovasc Res. 2009; 83: 465-472
        • Benowitz N.L.
        • Gourlay S.G.
        Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.
        J Am Coll Cardiol. 1997; 29: 1422-1431
        • Buch P.
        • Friberg J.
        • Scharling H.
        • Lange P.
        • Prescott E.
        Reduced lung function and risk of atrial fibrillation in The Copenhagen City Heart Study.
        Eur Respir J. 2003; 21: 1012-1016
        • Psaty B.M.
        • Manolio T.A.
        • Kuller L.H.
        • et al.
        Incidence of and risk factors for atrial fibrillation in older adults.
        Circulation. 1997; 96: 2455-2461
        • Heeringa J.
        • van der Kuip D.A.
        • Hofman A.
        • et al.
        Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam Study.
        Eur Heart J. 2006; 27: 949-953
        • Miyasaka Y.
        • Barnes M.E.
        • Gersh B.J.
        • et al.
        Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence.
        Circulation. 2006; 114: 119-125
        • Stewart S.
        • Hart C.L.
        • Hole D.J.
        • McMurray J.J.
        Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley Study.
        Heart. 2001; 86: 516-521
        • Benjamin E.J.
        • Rice K.M.
        • Arking D.E.
        • et al.
        Variants in ZFHX3 are associated with atrial fibrillation in individuals of European ancestry.
        Nat Genet. 2009; 41: 879-881