Elsevier

JACC: Heart Failure

Volume 11, Issue 3, March 2023, Pages 277-287
JACC: Heart Failure

Clinical Research
Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study

https://doi.org/10.1016/j.jchf.2022.07.006Get rights and content
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Abstract

Background

There is a lack of data for the incidence of heart failure (HF) according to changes in smoking behaviors.

Objectives

The authors aimed to investigate the effects of smoking behavior change on development of HF.

Methods

In this population-based, retrospective cohort study using the Korean National Health Insurance System database, the authors identified 778,608 current smokers who participated in a health screening program in 2009 and in a follow-up screening in 2011. Participants were categorized into quitters, reducers I (≥50% reduction) and II (<50% reduction), sustainers, and increasers.

Results

During a median follow-up of 6.3 years, there were 23,329 HF events (4.8 per 1,000 person-years). Compared with sustainers, the risk of HF was increased among increasers (adjusted hazard ratio [aHR]: 1.06 [95% CI: 1.02-1.10]). By contrast, quitters had a reduced risk for HF (aHR: 0.86 [95% CI: 0.83-0.90]). Even heavy smokers who quit smoking had a lower risk for HF than those who sustained heavy smoking (aHR: 0.90 [95% CI: 0.85-0.95]). In reducers, the risk of HF was not reduced but rather increased slightly (≥50% reduction, aHR: 1.06 [95% CI: 1.01-1.11]; <50% reduction, aHR: 1.04 [95% CI: 1.00-1.08]).

Conclusions

Current smokers who increased their smoking amount were associated with a higher risk for HF development compared to sustainers, whereas self-reported smoking cessation was associated with a lower risk of HF. There was no benefit from reduction in smoking amount. Self-reported smoking cessation should be reinforced whenever possible to prevent HF.

Key Words

cessation
change
heart failure
increase
reduction
smoking

Abbreviations and Acronyms

aHR
adjusted hazard ratio
BMI
body mass index
HF
heart failure
ICD-10
International Classification of Diseases-10th Revision
NHIS
National Health Insurance Service

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