Tobacco smoke exposure in pulmonary arterial and thromboembolic pulmonary hypertension.
BACKGROUND
Animal studies and data from a single-center study suggest that tobacco smoke exposure may be a risk factor for precapillary pulmonary hypertension (PH).


OBJECTIVE
We aimed to survey tobacco smoke exposure in a large PH collective and to compare it with epidemiological data from healthy subjects.


METHODS
This is an international, multicenter, case-control study including patients with pulmonary arterial and chronic thromboembolic PH. All patients were asked specific questions about tobacco smoke exposure. Healthy controls were retrieved from the Swiss Health Survey (n = 18,747).


RESULTS
Overall (n = 472), 49% of PH patients were smokers and there was a clear sex difference (women 37%, men 71%). Significantly more PH men were smokers compared with healthy controls, whereas less PH women were ever active smokers. However, 50% of the non-smoking PH women were exposed to secondhand smoke, leading to a significantly higher number of tobacco smoke-exposed individuals compared to healthy controls. PH smokers were significantly younger compared to those not exposed.


CONCLUSIONS
Active and environmental tobacco smoke exposure is common in PH. The higher prevalence of male PH smokers, the higher exposure to environmental tobacco smoke in PH women compared to healthy controls and the lower age at PH diagnosis in smokers may indicate a pathogenic role of tobacco smoke exposure in PH.
Clinic for Pulmonology and Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
Stephan
S
Keusch
Florian F
FF
Hildenbrand
Tom
T
Bollmann
Michael
M
Halank
Matthias
M
Held
Ralf
R
Kaiser
Gabor
G
Kovacs
Tobias J
TJ
Lange
Hans-Jürgen
HJ
Seyfarth
Rudolf
R
Speich
Silvia
S
Ulrich
D000368:Aged; D001317:Austria / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
D014028:Tobacco Smoke Pollution