Abstract
Smoking is a well-known risk factor for atherosclerotic cardiovascular disease. However, there are insufficient data regarding the predictive influence of smoking status on the risk of incident heart failure (HF). This study involved a systematic review and meta-analysis of prospective cohort studies to identify the association of smoking status with incident risk of HF. Peer-reviewed articles published in PubMed, Embase, Web of Science, Cochrane, and CINAHL up to May 2019 were identified. Seven studies, based on 42,759 participants and 4826 HF cases, were included. Pooled hazard ratios (HRs) and their 95% confidence intervals (CI) were estimated using the fixed effects model. Subgroup analyses were conducted to define possible sources of heterogeneity. Current smokers aged 18 years and over had a greater risk of HF incidence compared with non-smokers (never or former smokers) (HR = 1.609, 95% CI, 1.470–1.761). Additionally, former smokers had a greater risk of HF incidence compared with never smokers (HR = 1.209, 95% CI, 1.084–1.348). The present study highlighted that never smokers have more obvious cardiovascular benefits than current or former smokers. Therefore, health professionals should support cessation at the earliest among current smokers and encourage young people and non-smokers not to start smoking.
Highlights
The rapid worldwide growth of the aging population has led to an increasing incidence and prevalence of heart failure (HF) [1]
The trend was generally similar to the overall analysis. This meta-analysis of seven prospective cohort studies demonstrated that compared with never smokers, current and former smokers were at a greater risk of HF incidence
Tobacco smoking can cause endothelial dysfunction by reducing nitrogen monoxide production, pro-thrombotic conditions, and activating inflammatory routes [28,29,30,31]. These factors, along with the increased amounts of coronary atherosclerosis, may be responsible for the increase in the risk of hypertension [32], coronary heart disease [31] and atrial fibrillation [33,34], potentially contributing to the association of current smokers with higher HF incidence risk noted in the present study [30]
Summary
The rapid worldwide growth of the aging population has led to an increasing incidence and prevalence of heart failure (HF) [1]. HF is a chronic and progressive illness that is associated with high morbidity and mortality and medical costs owing to frequent hospital readmissions [2]. Despite advancements in medical and device therapy, HF continues to be associated with adverse outcomes and poor prognosis. The prevention of HF in community-based populations, is an important public health issue at the regional, national, and global levels [3]. Early identification of the relevant risk factors is crucial. There is a need to understand the factors influencing the risk of HF incidence
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