Smoking cessation, not smoking reduction, lowers heart failure risk: JACC

South Korea: A study investigating the effects of smoking behavior change on the development of heart failure (HF) found self-reported smoking cessation associated with a lower HF risk. No benefit was, however, seen with a reduction in the smoking amount.

Conversely, current smokers who increased their smoking amount were at a higher risk of heart failure development than sustainers; the researchers state in their study published in JACC: Heart Failure.

Smoking is a risk factor for HF independent of traditional risk factors. Smoking ups the risk of coronary artery disease, a significant cause of HF, and other effects of smoking result in HF and cardiac dysfunction.

Considering the lack of data on the incidence of heart failure according to changes in smoking behaviors, Jung Eun Yoo, Seoul National University Hospital, Seoul, Republic of Korea, and colleagues aimed to examine the effects of smoking behavior change on heart failure development.

For this purpose, the researchers identified 778,608 current smokers in the population-based, retrospective cohort study using the Korean National Health Insurance System database. 778,608 current smokers were the participants of a health screening program in 2009 and a follow-up screening in 2011. Participants were divided into quitters (those who stopped), reducers I (≥50% reduction) and II (<50% reduction) (those who decreased daily cigarette use but did not quit), sustainers (those who continued the same cigarette use or increased or decreased by less than 20%), and increases (those who increased daily cigarette use by 20% or more).

The study led to the following findings:

23,329 HF events (4.8 per 1,000 person-years) were reported During a median follow-up of 6.3 years

The risk of HF increased among increasers (adjusted hazard ratio [aHR]: 1.06) compared with sustainers.

By contrast, quitters had a reduced heart failure risk (aHR: 0.86).

Heavy smokers who quit smoking had a lower risk for HF than those who sustained heavy smoking (aHR: 0.90).

In reducers, the risk of HF was not reduced but increased slightly (≥50% reduction, aHR: 1.06; <50% reduction, aHR: 1.04).

The association between incident HF and smoking behavior change was more notable in men and younger people aged 40 to 64. Smoking cessation was tied to a decreased HF risk, regardless of baseline smoking levels.

The researchers wrote in their study that "the beneficial effects of self-reported smoking cessation on HF risk reduction was seen more prominently in younger participants than in older people. The greatest benefit of smoking cessation was observed in those who quit earliest in life."

Reference:

The study, "Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study," was published in the journal JACC: Heart Failure.

DOI: 10.1016/j.jchf.2022.07.006