title: Assessment of serum cotinine in patients with chronic heart failure: self-reported versus objective smoking behaviour.
abstract: BACKGROUND
  Smoking is a major risk factor in the development of coronary artery disease and thus chronic heart failure (HF). The value of self-reported smoking behaviour has not been validated in patients with HF. We sought to assess serum cotinine levels, a marker of recent tobacco exposure, in a cohort of clinically stable patients with chronic HF.
  
  
  RESULTS
  We analysed serum cotinine values in 75 patients with chronic HF [mean age ± SD 64 ± 16 years, 85 % male, left ventricular ejection fraction 30 ± 1 %, New York Heart Association class (I/II vs. III/IV) 73 %/27 %, haemoglobin (Hb) 13.4 ± 1.5 g/dL, serum creatinine 1.21 ± 0.51 mg/dL] and 30 control subjects of similar age (63 ± 11 years, 43 % male, Hb 14.1 ± 1.5 g/dL, creatinine 1.12 ± 0.92 mg/dL) using a chemiluminescence immunoassay. Patients were interviewed about their smoking habits, and routine laboratory parameters were analysed. In patients with HF, cotinine values ranged from undetectable to 829 μg/L (mean 110 ± 208 μg/L). Similar findings were evident in healthy subjects with cotinine ranging from undetectable to 860 μg/L (mean 105 ± 208 μg/L). Serum cotinine levels correlated with leukocyte count and haemoglobin concentration (both p < 0.05). Self-reported smoking behaviour did not correspond to serum cotinine level in serum in 16.9 % of the patients with chronic HF. No such finding was evident in control subjects.
  
  
  CONCLUSIONS
  Serum cotinine measurement provides an easily applicable means to analyse smoking behaviour in patients with chronic HF. Its assessment may permit analysis of smoking deception in daily clinical routine.
authors.affiliation: Department of Cardiology, Applied Cachexia Research, Charité Medical School, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ebner
authors.forename: Gabor
authors.initials: G
authors.lastname: Földes
authors.forename: Tibor
authors.initials: T
authors.lastname: Szabo
authors.forename: Matthias
authors.initials: M
authors.lastname: Tacke
authors.forename: Susann
authors.initials: S
authors.lastname: Fülster
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002908:Chronic Disease; D003367:Cotinine / Q000097:blood*; D003404:Creatinine / Q000097:blood; D005260:Female; D005858:Germany; D006184:Habits; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000097:blood* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D008131:London; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D057566:Self Report; D012907:Smoking / Q000009:adverse effects / Q000097:blood* / Q000523:psychology; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D003404:Creatinine; D003367:Cotinine