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

Seulggie Choi,Hyejin Lee,In Young Cho,Hye-Yeon Koo,Kiheon Lee,Sang Min Park,Kyuwoong Kim,Sung Min Kim,Jooyoung Chang,Mi Hee Cho,Joung Sik Son

doi:10.1186/s12889-020-8275-y

Abstract

BackgroundWhile 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.MethodsThis 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.ResultsThe 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.ConclusionsSmoking cessation after AF diagnosis was associated with reduced CVD, total stroke, and ischemic stroke risk.

Highlights

While smoking elevates the risk for cardiovascular disease (CVD) among atrial fibrillation (AF) patients, whether smoking cessation after AF diagnosis leads to reduced CVD risk is unclear
Sustained ex-smokers had 45% reduced risk and never smokers had 45% reduced risk for CVD compared to continual smokers among aspirin non-users
Never smokers among warfarin users had 48% reduced risk for CVD compared to continual smokers

Summary

Introduction

While smoking elevates the risk for cardiovascular disease (CVD) among atrial fibrillation (AF) patients, whether smoking cessation after AF diagnosis 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. The estimated global prevalence of atrial fibrillation (AF) patients was 33.5 million patients in 2010 [1]. AF patients are at two-fold increased risk of mortality [5], in large part due to the elevated risk for cardiovascular disease (CVD). It has been estimated that 20–30% of ischemic stroke patients have AF [6]. Identifying and managing modifiable risk factors for CVD among AF patients are of importance from clinical and public health perspectives

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