Smoking and Cardiac Structure and Function in the Elderly: The ARIC Study (Atherosclerosis Risk in Communities).
BACKGROUND
Cigarette smoking has been associated with higher risk of incident heart failure independent of coronary artery disease, but the impact of tobacco use on cardiac structure and function in the general population is uncertain. This study evaluated the relationship between smoking and echocardiographic measures in a large elderly cohort.


RESULTS
We studied 4580 participants free of overt coronary artery disease, heart failure, and significant valvular disease from the fifth visit of the ARIC study (Atherosclerosis Risk in Communities) who underwent transthoracic echocardiography. Participants were classified into 3 categories based on self-reported smoking habits: never (43.2%), former (50.5%), and current smokers (6.3%). Pack-years and years of smoking were also estimated. Compared with never smokers, current smokers had greater left ventricular (LV) mass index (80.4±1.1 versus 76.7±0.4 g/m(2); P<0.001), LV mass/volume ratio (1.93±0.03 versus 1.83±0.03 g/mL; P<0.001), higher prevalence of LV hypertrophy (15% versus 9%; P=0.008), and worse diastolic function, as reflected by higher E/E' ratio (11.7±0.2 versus 10.9±0.1; P<0.001), after adjusting for potential confounding factors. In contrast, former smokers showed similar echocardiographic features when compared with never smokers. Furthermore, estimated pack-years and years of smoking, measures of cumulative cigarette exposure, were associated with greater LV mass index, LV mass/volume ratio, and worse diastolic function (higher E/E' ratio) in current smokers after multivariable analysis (all P<0.01).


CONCLUSIONS
Active smoking and cumulative cigarette exposure were associated with subtle alterations in LV structure and function in an elderly, community-based population free of overt coronary artery disease and heart failure.
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Wilson
W
Nadruz
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Brian
B
Claggett
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Alexandra
A
Gonçalves
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Gabriela
G
Querejeta-Roca
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Miguel M
MM
Fernandes-Silva
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Amil M
AM
Shah
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Susan
S
Cheng
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Hirofumi
H
Tanaka
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Gerardo
G
Heiss
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.).
Dalane W
DW
Kitzman
From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.C., A.G., G.Q.-R., M.M.F.-S., A.M.S., S.C., S.D.S.); Department of Internal Medicine, University of Campinas, Brazil (W.N.); Department of Physiology and Cardiovascular Surgery, University of Porto Medical School, Portugal (A.G.); Department of Kinesiology and Health Education, University of Texas, Austin (H.T.); Department of Epidemiology, University of North Carolina, Chapel Hill (G.H.); and Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.). ssolomon@rics.bwh.harvard.edu.
Scott D
SD
Solomon
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
atherosclerosis; echocardiography; epidemiological studies; heart failure; smoking