Abstract P155: Smoking, Its Cessation, and Future Risk of Heart Failure: the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Smoking is considered as a major risk factor for cardiovascular disease, including heart failure (HF). Few studies have evaluated the prospective association of detailed smoking parameters (including duration, intensity, and cessation) with incident HF. Hypotheses: These smoking parameters will be associated with incident HF. Methods: In 14,010 ARIC participants free of a history of HF at baseline (1987-89), we quantified the associations of smoking parameters (pack-years, duration, and intensity [pack/day]) with incident HF (hospitalizations with HF diagnosis [ICD-9: 428.0-428.9] or a death certificate ICD-9 code 428.0-428.9 or ICD-10 code I50.0-I50.9) using Cox models. Years since quitting in former smokers (<5, 5-9, 10-19, 20-29, and ≥30 years) were explored as time-varying variables, with time-varying covariates whenever possible. Results: Over a median follow-up of 26 years, there were 3,047 cases of HF. Pack-years was significantly associated with incident HF (HR 1.31 [95% CI 1.28-1.35] per 20 pack-years). Both smoking duration and intensity showed significant associations with HF (HR 1.62 [1.55-1.70] per 20 years of smoking and 1.43 [1.36-1.50] per 1 pack/day). Smoking cessation demonstrated a graded association with HF, with significantly increased risk even after cessation for ≥30 years (1.16 [1.04-1.31]) (Table-Model 2). After further adjusting for incident coronary events, the association was attenuated but remained significant up to cessation for 10-19 years (Table-Model 3). Conclusions: All smoking parameters tested in this study consistently show significant associations with incident HF. The HF risk related to smoking lasted at least 19 years after its cessation. Our results further highlight the importance of smoking prevention and early smoking cessation for the prevention of HF.