0
Original Research: Pulmonary Vascular Disease |

The Impact of Smoking on Thromboembolism and Mortality in Patients With Incident Atrial FibrillationSmoking and Thromboembolism in Atrial Fibrillation: Insights From the Danish Diet, Cancer, and Health Study

Ida Ehlers Albertsen, BSc; Lars Hvilsted Rasmussen, PhD; Deirdre A. Lane, PhD; Thure Filskov Overvad, BSc; Flemming Skjøth, PhD; Kim Overvad, PhD; Gregory Y. H. Lip, MD; Torben Bjerregaard Larsen, MD, PhD
Author and Funding Information

From the Department of Cardiology (Ms Albertsen, Mr Overvad, and Drs Skjøth and Larsen), Aalborg Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark; Thrombosis Research Centre (Drs Rasmussen, Lip, and Larsen), Aalborg University, Aalborg, Denmark; the Section for Epidemiology (Dr Overvad), Department of Public Health, Aarhus University, Aarhus, Denmark; and the University of Birmingham Centre for Cardiovascular Sciences (Ms Albertsen, Drs Lane and Lip, and Mr Overvad), City Hospital, Birmingham, England.

Correspondence to: Torben Bjerregaard Larsen, MD, PhD, Department of Cardiology, Aalborg AF Study Group, Aalborg Hospital, Aarhus University Hospital, Forskningens Hus, Søndre Skovvej 15, DK-9100 Aalborg, Denmark; e-mail: tobl@rn.dk


Drs Lip and Larsen served as joint senior authors on this article.

This study was reported in a poster presentation at the American Heart Association’s Scientific Sessions, November 6, 2012, Los Angeles, CA, and at the European Congress of Epidemiology, August 12, 2013, Aarhus, Denmark.

Funding/Support: The Danish Cancer Society financially supported the Diet, Cancer and Health study [Grant 91-8501].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):559-566. doi:10.1378/chest.13-1740
Text Size: A A A
Published online

Background:  Smoking and atrial fibrillation (AF) are major health problems worldwide and are responsible for substantial health-care costs. Our aim was to investigate whether smoking impacts the risk of stroke and death in patients with AF. To test this hypothesis, we analyzed data from a large Danish cohort: the Diet, Cancer, and Health study.

Methods:  This was a cohort study of 57,053 people (27,178 men; 29,876 women) aged 50 to 64 years. The risk of thromboembolism (ischemic stroke/arterial thromboembolism) or death according to smoking habits among 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 smokers and 37% former smokers. After adjustment for vitamin K antagonist treatment, the hazard ratios (HRs) (95% CI) of thromboembolism or death were 3.13 (1.72-6.37) and 2.73 (2.02-3.70) among women and men who currently were heavy smokers (> 25 g/d), respectively. The associations remained 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-recognized risk factors used in stroke risk stratification schemes. The associations may be modified by sex, as the associations were strongest among women.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543