Effects of Smoking on Ischemic Stroke, Intracranial Hemorrhage, and Coronary Artery Events in Japanese Patients With Non-Valvular Atrial Fibrillation

Abstract

SummaryThe effects of smoking on the prognosis of non-valvular atrial fibrillation (NVAF) patients are unclear. The Shinken Database 2004-11 (n = 17,517) includes all new patients visiting the Cardiovascular Institute between June 2004 and March 2012. Among these cases, 2,102 NVAF patients were identified. The effects of smoking on ischemic stroke (IS), intracranial hemorrhage (ICH), and coronary artery events including percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS) were analyzed. Smokers were younger and had lower risk profiles compared with non-smokers. A similar tendency was observed between current and former smokers. In contrast, patients with high tobacco consumption were older and had higher risk profiles, including uncontrolled hypertension, compared with those with low tobacco consumption. In 8,159 patient-years, IS, ICH, PCI, and ACS occurred at rates of 7.7, 2.7, 12.4, and 3.0 per 1000 patient-years. In multivariate Cox regression analysis, smoking was not significantly associated with any adverse event. However, different effects of smoking were observed when stratified by age. In patients ≥ 65 years old, current smokers were independently associated with PCI. Moreover, current smokers and smokers with a total tobacco amount ≥ 800 were marginally and independently associated with IS. In patients < 65 years, current smokers were independently associated with ICH.Age appears to be one of the contributors to differentiation of the effects of smoking on cardiovascular events in our NVAF patients. In elderly patients who still smoke, smoking was associated with the promotion of atherosclerosis or thromboembolism, whereas in young patients it was associated with bleeding. (Int Heart J 2017; 58: 506-515)

Patient Satisfaction with Direct Oral Anticoagulants and Warfarin

“…The study results can be summarized as follows: (1) The ACTS burden scores were significantly higher among the DOAC users than those among the warfarin users, and the higher scores were independent of age, sex, and other clinical variables. The ACTS benefits scores were somewhat higher among the warfarin users than among the DOAC users, and prolonged anticoagulant therapy was the strongest determinant of satisfaction shown on the benefits scale.…”

Heat‐not‐burn tobacco (IQOS), oral fibroblasts and keratinocytes: cytotoxicity, morphological analysis, apoptosis and cellular cycle. An in vitro study

“…Despite over 8 million deaths per year that can be directly attributed to it, there are still about 1.3 billion smokers worldwide. 1 Smoking is the main cause of mortality due to cardiovascular diseases like atherosclerosis and its consequences, 2 respiratory disorders such as chronic obstructive bronchopathy (COPD), 3 , 4 chronic bronchitis and pulmonary emphysema, 5 bone disorders such as osteoporosis 6 , 7 as well as cancer, particularly lung, bladder, liver, breast and oral malignancies. 8 , 9 Consequently, governments worldwide have promoted anti‐smoking campaigns and laws.…”

The Smoking Paradox in Stroke Patients Under Reperfusion Treatment Is Associated With Endothelial Dysfunction

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