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Smoking may increase heart failure risk among African-Americans

April 16, 2018

DALLAS, April 16, 2018 -- African Americans who smoke appear to be at far greater risk of developing heart failure than those who never smoked, or those who quit, according to new research in the American Heart Association's journal Circulation.

"Previous research has focused on smoking and atherosclerosis, or hardening of the arteries, but not enough attention has been given to the other bad effects of smoking on the heart," said Michael E. Hall, M.D., M.S., a cardiologist at the University of Mississippi Medical Center in Jackson and senior study author. "With increasing rates of heart failure, particularly among African Americans, we wanted to look at the link between smoking and heart failure."

Patients with heart failure are unable to pump enough blood and oxygen to their bodies to remain healthy. According to the American Heart Association, 1 of every 5 Americans over the age of 40 is expected to develop heart failure in their lifetime--and that number is growing.

The study included 4,129 participants in the Jackson Heart Study with a median follow up of 8 years. At enrollment, none of the participants (average age 54) had heart failure or hardening of the arteries, which can lead to heart failure. Among participants there were 2,884 people who never smoked, 503 who were current smokers and 742 who were former smokers. During the study period, there were 147 hospitalizations for heart failure.

The study found hospitalizations for heart failure were:
  • Nearly three times more likely among current smokers;
  • Three-and-a-half times more likely among current smokers who smoked a pack or more a day; and
  • Twice as likely among those with a smoking history equivalent to smoking a pack a day for 15 years.


Researchers also found a link between current smoking and a larger left ventricle, the heart's main pumping chamber, which showed early signs that the left ventricle was not working properly. Hall said these changes in the left ventricle's structure and function likely put a person at greater risk of developing heart failure.

Importantly, researchers did not find a link between former smokers and heart failure hospitalization or changes in the left ventricle.

The study took into account high blood pressure, diabetes, body mass and other factors that might have biased results. Researchers said the association between smoking, heart failure hospitalizations and left ventricle changes remained even after also accounting for those participants who developed coronary heart disease during the study period.

Study limitations include the fact that the participants lived in only three counties in the Jackson, Mississippi metropolitan area, so findings may not be generalizable to African Americans living elsewhere.

"Still, the study clearly underscores the harms of smoking and the benefits of quitting," Hall said. As healthcare professionals, we would recommend that all patients quit smoking anyway, but the message should be made even more forcefully to patients at higher risk of heart failure."
-end-
Co-authors are Daisuke Kamimura, M.D., Ph.D.; Loretta R. Cain, Ph.D.; Robert J. Mentz, M.D.; Wendy B. White, Ph.D.; Michael J. Blaha, M.D., M.P.H.; Andrew P. DeFilippis, M.D., M.S.; Ervin R. Fox, M.D. M.P.H; Carlos J. Rodriguez, M.D., M.P.H.; Rachel J. Keith, Ph.D., N.P.; Emelia J. Benjamin, M.D., Sc.M; Javed Butler, M.D., M.P.H.; Aruni Bhatnagar, Ph.D.; Rose M. Robertson, M.D.; Michael D. Winniford, M.D.; and Adolfo Correa, M.D., M.P.H., Ph.D. There were no author disclosures.

The National Heart, Lung, and Blood Institute and the National Institute for Minority Health and Health Disparities funded the study.

Additional Resources:

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at http://www.heart.org/corporatefunding.

About the American Heart Association

The American Heart Association is devoted to saving people from heart disease and stroke - the two leading causes of death in the world. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation's oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country. Follow us on Facebook and Twitter.

American Heart Association

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