Smoking cessation reduces dementia risk in patients with newly diagnosed AF: JAMA
South Korea: A cohort study conducted by researchers in South Korea showed that smoking cessation after AF diagnosis was associated with a lower risk of dementia than among current smokers. Study findings, published in JAMA Network Open promote smoking cessation within an integrated care approach to AF patient management.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major risk factor for ischemic stroke. The incidences of AF are continuously increasing and pose public health challenges in developing countries like India by increasing economic burden along with significant morbidity and mortality. Several studies have shown AF as a risk factor for cognitive decline or incident dementia but limited data is available about the association of lifestyle modifications with the incidence of dementia in AF. Smoking has been established as the most common risk factor for AF, stroke, and dementia but current guidelines substantially undervalue the role of quitting smoking in the management of AF.
Hui-Jin Lee, Seoul National University Hospital, South Korea, and colleagues sought to determine the association between quitting smoking and the risk of incident dementia in patients with newly diagnosed AF.
Researchers used data from 126 252 patients from the Korean National Health Insurance Service database. Based on their smoking status, participants were classified as never smokers, ex-smokers, quit smokers, and current smokers. Patients were followed up until dementia, death, or the study period ended, whichever occurred first. The primary outcome was Dementia, including Alzheimer's disease and vascular dementia. Hazard ratios were estimated by Cox proportional hazards regression model.
The key findings of the study are as follows:
- The mean CHA2DS2-VASc score, which measures the risk of ischemic stroke, was 2.7.
- The smoking status of the total study population was as follows: 65 579 never smokers (51.9%), 34 670 ex-smokers (27.5%), 8919 quit smokers (7.1%), and 17 084 current smokers (13.5%).
- During a median of 3 years of follow-up, dementia occurred in 5925 patients (1.11 per 1000 person-years).
- After multivariable adjustment, the risk of quit smokers was significantly lower than that of current smokers (hazard ratio, 0.83).
From the study findings, the authors suggest that all types of smoking status were associated with a significantly higher risk of dementia in patients with new-onset AF. However, smoking cessation after AF diagnosis was associated with a lower risk of dementia than current smoking.
Smoking cessation should be advocated in patients with newly diagnosed AF to reduce the burden of AF-related dementia, the authors suggested.
Reference:
Lee H, Lee S, Choi E, et al. Risk of Dementia After Smoking Cessation in Patients With Newly Diagnosed Atrial Fibrillation. JAMA Netw Open. 2022;5(6):e2217132. doi:10.1001/jamanetworkopen.2022.17132
