Smoking as a Risk Factor for the Occurrence of Atrial Fibrillation in Men Versus Women: A Meta-Analysis of Prospective Cohort Studies.
BACKGROUND
Although smoking is known to be associated with cardiovascular diseases, the number of large-scale cohort studies on the association between smoking and atrial fibrillation (AF) is limited and the results obtained are also inconsistent, and even fewer studies have addressed the difference between the male and female genders. The present study was intended to clarify and quantify the association between smoking and the risk of AF in men versus women.


METHODS
Using AF- and smoking-related keywords, a comprehensive literature search on PubMed, Embase and Web of Science was conducted with a time limit until December 2016, which was followed by manual screening, quality assessment and data extraction. The pooled relative risk (RR) of the included studies was estimated by using the random-effects model. Subgroup, heterogeneity and sensitivity analyses were also conducted.


RESULTS
A total of 14 prospective studies and 222,159 individuals were included in this meta-analysis, and the pooled RR of the 14 studies was 1.24 (95% CI, 1.12-1.36; p<0.0001) for the occurrence of AF in smoking populations. The pooled RR in men was 1.38 (95% CI, 1.21-1.57 p<0.0001) versus 1.28 in women (95% CI, 0.93-1.76; p=0.1356). The male-to-female ratio of relative risk (RRR) was 1.17 (95% CI, 0.84-1.63; p=0.3418) of smoking versus non-smoking individuals.


CONCLUSIONS
Smoking is a risk factor for the occurrence of AF. Compared with women, male smokers are more likely to develop AF.
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Qing
Q
Wang
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Yibin
Y
Guo
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Cheng
C
Wu
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Liang
L
Yin
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Wei
W
Li
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Hua
H
Shen
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Wang
W
Xi
Department of Health Statistics, Second Military Medical University, Shanghai, China.
Tianyi
T
Zhang
Department of Health Statistics, Second Military Medical University, Shanghai, China. Electronic address: hejia63@yeah.net.
Jia
J
He
Center for Comprehensive Treatment of Atrial Fibrillation, Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: wangzn007@163.com.
Zhinong
Z
Wang
D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology
Atrial fibrillation; Gender difference; Risk factors; Smoking