Smoking intensity and duration is associated with cardiac structure and function: the ECHOcardiographic Study of Hispanics/Latinos

Abstract

ObjectiveCardiovascular disease is the leading cause of death in smokers and this relationship is complicated by the multiplicity of cardiovascular effects of smoking. However, the relationship between intensity and duration of cigarette smoking and echocardiographic measures of right and left ventricular structure and function has been poorly studied.MethodsWe examined ECHO-SOL (Echocardiographic Study of Hispanics/Latinos) participants, a subset of the Hispanic Community Health Study/Study of Latinos. Participants were administered a detailed tobacco exposure questionnaire and a comprehensive echocardiography exam. Multivariable linear regression models (adjusted for age, sex, obesity, hypertension and diabetes statuses) were performed using sampling weights. Statistical significance was defined at p<0.01.ResultsThere were 1818 ECHO-SOL participants (57.4% women, mean age 56.4 years). Among current smokers (n=304), increased duration of smoking, as measured by a younger age of smoking initiation, was significantly associated with higher mean left ventricular mass (LVM) and lower right ventricular (RV) function (lower right ventricular stroke volumes). More cigarettes smoked per day was significantly associated with higher mean LVM, worse diastolic function (higher E/e′ ratio), worse LV geometry (increased relative wall thickness) and worse RV function (decreasing right ventricular stroke volume). Among current smokers, higher mean lifetime pack-years (a combined measure of smoking intensity and duration) was associated with higher LVM, worse LV geometry, worse diastolic function, greater RV dilatation and worse RV function.ConclusionsThere is a dose–response relationship between intensity and duration of cigarette tobacco smoking with unfavourable changes of multiple measures of right-sided and left-sided cardiac structure and function.

Childhood and adult exposure to secondhand tobacco smoke and cardiac structure and function: results from Echo-SOL

“…The results of this study contribute to the emerging body of evidence regarding the adverse effects of exposure to tobacco smoke on cardiac structure and function, which has primarily been studied in active current smokers. Within Echo-SOL, increased pack-years of tobacco smoking was associated with decreased systolic and diastolic function and increased cigarettes smoked per day were associated with increased LV mass 23. A study of the Coronary Artery Risk Development in Young Adults (CARDIA) cohort found that tobacco smoking was associated with a trend towards increased LV mass in all groups except for African-American men and increased LV stress in women; however, the echocardiographic variables in this study were limited to linear measurements, and 2D quantitation was not performed 24.…”

Influence of cigarette smoking on biventricular systolic function independent of respiratory function: a cross-sectional study

“…These findings reveal that cigarette smoking exposure may result in the development of cardiac dysfunction in a direct and continuous dose-dependent fashion and thus, may contribute to the heart failure epidemic. There were several previous studies regarding the relationship between smoking exposure and worsening cardiac function [1,6,[23][24][25]. Specifically, some studies reported that LV mass index could increase with higher exposure to smoking [5,6].…”

“…Several mechanisms regarding smoking exposure and cardiovascular dysfunction have been suggested previously. In animal models, cigarette smoking has been shown to induce ventricular hypertrophy and remodeling with increased serum levels of norepinephrine [6]. Continuous exposure to smoking could stimulate the autonomic nervous system and induce cardiac remodeling [6].…”

“…In animal models, cigarette smoking has been shown to induce ventricular hypertrophy and remodeling with increased serum levels of norepinephrine [6]. Continuous exposure to smoking could stimulate the autonomic nervous system and induce cardiac remodeling [6]. These injury models would have effects on the RV function as well as the LV function [6].…”

“…Continuous exposure to smoking could stimulate the autonomic nervous system and induce cardiac remodeling [6]. These injury models would have effects on the RV function as well as the LV function [6]. Furthermore, cigarette smoking could cause subclinical cardiovascular damage [31].…”