Association of smoking cessation after atrial fibrillation diagnosis on the risk of cardiovascular disease: a cohort study of South Korean men

Abstract

Background: While smoking elevates the risk for cardiovascular disease (CVD) among atrial fibrillation (AF) patients, whether smoking cessation after AF diagnosis actually leads to reduced CVD risk is unclear. We aimed to determine the association of smoking cessation after AF diagnosis with subsequent CVD Risk among South Korean men. Methods: This retrospective cohort study included 2372 newly diagnosed AF male patients during 2003-2012 from the Korean National Health Insurance Service database. Self-reported smoking status within 2 years before and after diagnosis date were determined, after which the participants were divided into continual smokers, quitters (smokers who quit after AF diagnosis), sustained-ex smokers (those who quit prior to AF diagnosis), and never smokers. Participants were followed up from 2 years after AF diagnosis until 31 December 2015 for CVD. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for CVD according to the change in smoking habits before and after AF diagnosis. Results: The mean (standard deviation, minimum-maximum) age of the study subjects was 62.5 (8.6, 41-89) years. Among AF patients, quitters had 35% reduced risk (aHR 0.65, 95% CI 0.44-0.97) and never smokers had 32% reduced risk (aHR 0.68, 95% CI 0.52-0.90) for CVD compared to continual smokers (p for trend 0.020). Similarly, compared to continual smokers, quitters had 41% risk-reduction (aHR 0.59, 95% CI 0.35-0.99) and never smokers 34% risk-reduction (aHR 0.66, 95% CI 0.46-0.93) for total stroke (p for trend 0.047). Quitters had 50% reduction (aHR 0.50, 95% CI 0.27-0.94), sustained ex-smokers had 36% reduction (aHR 0.64, 95% CI 0.42-0.99), and never smokers had 39% reduction (aHR 0.61, 95% CI 0.41-0.91) in ischemic stroke risk (p for trend 0.047). The risk-reducing effect of quitting on CVD risk tended to be preserved regardless of aspirin or warfarin use. Conclusions: Smoking cessation after AF diagnosis was associated with reduced CVD, total stroke, and ischemic stroke risk.

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death

“…Previous studies have reported the impact of smoking status on cardiovascular outcomes in patients with AF [ 7 , 8 , 35 ]. One clinical cohort trial suggested that smoking may increase the risk of thromboembolic events in patients with anticoagulated AF by 2-fold [ 7 ].…”

“…In the Danish Diet, Cancer and Health cohort study, which included 3161 patients with incident AF, smoking did not show a significant increase in the risk of stroke in both men and women; however, this study did not include an analysis of the impact of quitting smoking after AF diagnosis [ 8 ]. Another recent study evaluated the association between smoking habits and the incidence of cardiovascular outcomes in patients with AF [ 35 ]. Although this study showed similar results to those of the current study, our study has several additional strengths.…”

“…Third, the study period differed between the two studies. The previous report by Choi et al [ 35 ] analyzed data from 2003 to 2012, when warfarin was the only option for OAC therapy and OAC prescription was low (approximately 15% of the total population). In the present study, we included patients from 2010 to 2016 with a much higher OAC treatment rate (approximately 25% of the total population), including 7905 patients treated with DOACs.…”

Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry

“…6) In South Korea, 41% of coronary artery diseases (CADs) and 26% of cerebrovascular disease are caused by tobacco, attributable to the high prevalence of smoking in adult Korean men. 7) 8) The smoking rate in adult Korean men declined rapidly from 79% in 1980 to 45% in 2007, but the rate of decline has slowed recently. 9) According to the 2018 National Health and Nutrition Survey report, the smoking rate in adult men was 36.7%.…”

Reinforcing Synthetic Data for Meticulous Survival Prediction of Patients Suffering From Left Ventricular Systolic Dysfunction

“…The studies have reported that the aging process causes the progressive loss of physiological development at molecular, cellular and tissue levels which leads to an increase in CVDs [4]. On the other hand, several seminal researchers explored the link between CVDs and diabetes, which shows that CVDs are most prevalent cause of death in diabetic patients [5]- [7]. The level of the glucose gets high in diabetic patients which can damage the artery wall and increases deposition of fat in the coronary arteries, which might lead to possible heart arrest.…”