Abstract 9434: Cigarette Smoking and Incident Heart Failure With Preserved Ejection Fraction in African Americans: The Jackson Heart Study

Background: Cigarette smoking has been associated with incident heart failure (HF), however the relationships with HF phenotypes have not been adequately investigated, particularly in African Americans. Methods and Results: Among 4129 African Americans participants in the Jackson Heart Study without a history of HF or coronary heart disease (CHD) at baseline, we investigated the relationships between baseline smoking status, smoking intensity (number of cigarettes/day) among current smokers, and smoking burden (pack years) among ever smokers and incident HF hospitalization. HF phenotypes were categorized either as HF with reduced ejection fraction (HFrEF: EF<50%) or HF with preserved EF (HFpEF: EF≥50%). There were 2884 (70%) never smokers, 503 (12%) current smokers, and 742 (18%) former smokers. Over a median of 11.0 years follow-up (interquartile range: 10.4-11.0), there were 215 incident HF hospitalizations (95 incident HFrEF, 120 incident HFpEF). After adjustment for traditional risk factors of age, sex, body mass index, systolic blood pressure, anti-hypertensive medication, diabetes, estimated glomerular filtration rate, and incident CHD, current smoking was associated with incident HFpEF (hazard ratio, 3.21; 95% confidence interval, 1.80-5.71), but not with incident HFrEF in comparison with never smokers. Smoking intensity among current smokers (hazard ratio, 1.06 per 1 cigarette/day; 95% confidence interval, 1.02-1.09), and smoking burden among ever smokers (hazard ratio, 1.08 per 10 pack-years; 95% confidence interval, 1.01-1.16) were also significantly associated with incident HFpEF but not with incident HFrEF (Table). Conclusion: In this large community-based African American cohort, cigarette smoking (smoking status, smoking intensity, and smoking burden) was significantly associated with incident HFpEF, but not with HFrEF. Smoking cessation in African Americans who smoke may reduce risk for HFpEF in this high-risk population.