Cigarette Smoking Doubles the Risk of Developing Both Types of Heart Failure

People who smoked tobacco cigarettes developed heart failure at 2 times the rate of people who never smoked, according to a study published in the June issue of the Journal of the American College of Cardiology. The research is one of the first to assess smoking in both types of heart failure — reduced ejection fraction and preserved ejection fraction — and found that smoking is significant risk factor for both.

“These findings underline the importance of preventing smoking in the first place, especially among children and young adults.” said study senior author Kunihiro Matsushita, MD, PhD, associate professor in the department of epidemiology at Bloomberg School in Baltimore, in a release. “We hope our results will encourage current smokers to quit sooner rather than later, since the harm of smoking can last for as many as three decades,” he said.

Heart Failure Contributes to 1 in 8 Deaths
An estimated 6.5 million people in the United States have heart failure, and it contributes to 1 in 8 deaths, according to the Centers for Disease Control and Prevention (CDC).

Heart failure (HF) describes a condition where the heart isn’t able to pump enough blood to meet the body’s requirements for oxygen and blood, according to the American Heart Association (AHA).

There are two types of heart failure: reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). In heart failure with reduced ejection fraction, the left ventricle, which is the principal cardiac pump, doesn’t contract sufficiently when pumping blood outward. In heart failure with preserved ejection fraction, the left ventricle doesn’t relax properly after contracting.

When a person has heart failure the heart tries to compensate in different ways: It enlarges, develops more muscle mass, and it pumps faster. The rest of the body also tries to make up for the deficit by diverting blood away from less important tissues and organs and the blood vessels narrow to keep blood pressure up, according to the AHA.

Prevention Is Especially Important in Heart Failure With Preserved Ejection Fracture
Heart failure with reduced ejection fraction is more closely tied to coronary artery disease and there several treatment options that can improve prognosis, but for people with heart failure with preserved ejection fraction, treatment options are very limited, according to the authors.

That makes prevention especially important, but the risk factors for this type of heart failure are less clear, according to the authors. Some prior studies have linked smoking to higher risk of preserved ejection fraction, while others have not, they wrote.

Cigarette Smokers Twice as Likely to Develop Heart Failure
To further explore and quantify the association of cigarette smoking and stopping smoking with the incidence of both types of heart failure, researchers used data from 9,345 participants who were enrolled in the Atherosclerosis Risk in Communities (ARIC) study. The study participants were between ages 61 and 81 and from four communities — in Maryland, North Carolina, Minnesota, and Mississippi — with substantial representation of Black individuals. To be enrolled in the trial, participants had to have sufficient health records and no diagnosis of heart failure in 2005 when the trial first began. 

Over a median follow-up of 13 years, there were 1,215 cases of heart failure in the study, including 492 cases of reduced ejection fraction and 555 cases of preserved ejection fraction.

Smokers in each group were more likely to have developed heart failure compared with never smokers — 2.28 times more likely in the preserved ejection fraction group, and 2.16 times for reduced ejection fraction group. 

The link with smoking also showed a “dose-response” relationship — the more cigarettes smoked per day and more years of smoking were associated with higher heart failure risk. Similarly, quitting smoking led to a reduction in heart failure risk that increased over time.

Overall, former smokers were 31 percent and 36 percent more likely to have preserved ejection fraction and reduced ejection fraction, respectively, compared with never-smokers. 

Investigators then grouped former smokers according to the number of years since they quit and found that the former smokers’ overall heart failure risk remained significantly higher than never-smokers’ risk — except for the group that hadn’t smoked for 30 years or more. 

“These findings have significant implications in understanding the role of smoking in the progression of cardiovascular disease, and the potential mitigation of disease with smoking cessation,” says Loren Wold, PhD, professor of physiology and cell biology in the College of Medicine at The Ohio State University in Columbus, who studies the effect of novel tobacco products on cardiovascular health. Dr. Wold was not involved in this research. “This study provides insight into the time course of disease mitigation following smoking cessation, with the effects of smoking lingering for decades,” he says.

Smoking Contributes to Hypertension, Insulin Resistance and Blockage of the Arteries
In the editorial “Is Smoking Cessation the Best Intervention Ever to Prevent Heart Failure?” the authors wrote that smoking is detrimental to the heart for a multitude of reasons, in part because smoking directly leads to oxidative stress, inflammation, vasoreactivity, hypertension, insulin resistance, and blockage of the arteries.

According to the editorial, these factors may have a direct as well as indirect damaging effects on the myocardium (the muscular tissue of the heart) as well as the interplay between the heart and the other organs and systems involved in heart failure, including the kidneys, lungs, and arteries.

In addition to cigarette smoking, eating foods high in fat, cholesterol, and sodium; not getting enough physical activity; and excessive alcohol intake have all been identified as behaviors that can increase the risk of heart failure.

Medical conditions can also increase the risk of heart failure, and include coronary artery disease (CAD), diabetes, high blood pressure, obesity, valvular heart disease, and other conditions related to heart disease, according to the CDC.

Study Reinforces the Need for Smokers to Actively Work on Quitting
This study adds significant understanding of how long a smoker may suffer from an increased risk of smoking-induced cardiovascular disease, says Wold. “It also helps reinforce the need for smokers to actively work on quitting,” he adds.

If you’re ready to stop smoking, the CDC website offers many resources to get you started. In addition to motivational tactics, such as free over-the-phone coaching and inspirational texts, the CDC lists many medications your doctor can prescribe that can more than double your chances of successfully kicking the habit, according to the agency.