title: Impact of persistent smoking on long-term outcomes in patients with nonvalvular atrial fibrillation.
abstract: BACKGROUND
  Although smoking is a risk factor for cardiovascular diseases, little is known about the impact of smoking on long-term outcomes in patients with atrial fibrillation (AF).
  
  
  METHODS
  In 426 consecutive patients with nonvalvular AF (mean age, 66 years; 307 men; mean follow-up, 5.8±3.2 years), clinical variables including smoking status, CHADS2, and CHA2DS2-VASc score, incidences of cardiovascular events (stroke, myocardial infarction, or admission for heart failure), bleeding, and mortality were determined.
  
  
  RESULTS
  Incidences of intracranial bleeding (0.7% vs 0.1%/year, p<0.01), all-cause mortality (4.9% vs 2.6%/year, p<0.01), and death from stroke (0.8% vs 0.2%/year, p<0.05) were higher in patients with history of smoking than in those without it. Incidence of intracranial bleeding was significantly higher in persistent smokers than in non-persistent smokers (1.2% vs 0.2%/year, p<0.01). History of smoking predicted all-cause mortality [hazard ratio (HR), 2.7; 95% confidence interval (CI), 1.7-4.5; p<0.01] and death from stroke (HR 4.7; 95% CI 1.0-22.3; p<0.05) independent of age, antithrombotic treatment, CHADS2, and CHA2DS2-VASc score. Persistent smoking predicted intracranial bleeding (HR 4.4; 95% CI 1.1-17.6; p<0.05) independent of age and antithrombotic treatment.
  
  
  CONCLUSIONS
  Smoking status, independent of age, antithrombotic treatment, and clinical risk factors, predicted long-term adverse outcomes including bleeding events in patients with nonvalvular AF. There might be an obvious impact of persistent smoking on intracranial bleeding.
authors.affiliation: Center for Health Care and Human Sciences, University of Toyama, Toyama, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan. Electronic address: thirai@med.u-toyama.ac.jp.
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Ohara
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fukuda
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Numa
authors.affiliation: Department of Neurology, University of Toyama, Toyama, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Taguchi
authors.affiliation: Department of Neurology, University of Toyama, Toyama, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Dougu
authors.affiliation: Department of Neurology, University of Toyama, Toyama, Japan.
authors.forename: Shutaro
authors.initials: S
authors.lastname: Takashima
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nozawa
authors.affiliation: Department of Neurology, University of Toyama, Toyama, Japan.
authors.forename: Kortaro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D020521:Stroke / Q000453:epidemiology / Q000401:mortality
keywords: Nonvalvular atrial fibrillation; Prognosis; Smoking