Smoking is a well-recognized risk factor for CVD and also affects other risk factors for heart disease such as hypertension, diabetes. Now a new study published earlier this week in the Journal of the American Heart Association has said that a heart attack or a stroke may often be the first presentation of heart disease among current smokers.

The pooled analysis of nine long-term cohort studies evaluated data from 106,165 adults with ages ranging from 20 to 79 years. Half of them were women and half were smokers. None of the participants had a heart disease at the time of enrollment. For the present study, persons who smoked were divided into groups according to age (young [20-39 years]; middle-aged [40-59 years] and older [60-79 years), sex and self-reported smoking status (either yes or no). The follow up period ranged between 10 and 25 years. The association of different types of CVD, including fatal and nonfatal events with smoking status were analyzed.

There were 7002 new fatal or nonfatal coronary heart disease events, 3527 new fatal or nonfatal strokes and 4559 incident HF events in middle-aged adults during the course of the study. The cardiac-related deaths numbered 6224, while non-cardiac deaths were 11,578.

The odds of having a fatal CVD event as the first sign of CVD was two-folds higher in middle-aged women who smoked compared to nonsmoking women and 1.5 times higher in middle-aged men who smoked compared to middle-aged men who did not smoke.

Both middle-aged women and men smokers had a 10% higher long-term risk of developing CVD; 34.7% for women smokers vs 24.8% for women non-smokers and 46% for men smokers vs 35.8% for men non-smokers. Middle aged men developed CVD five years earlier, while the development of cardiovascular disease was seen four years earlier in middle-aged women. Early onset of heart disease was also observed in younger and older adults.

Analysis of data from the 20-39 year age group revealed a significant increase in the risk of heart disease at 10 years of follow up in young men who smoked, while in young women smokers, the risk of heart disease was evident at 20 years of follow up. Heart attacks were more common among young men who smoked (24%), while stroke or heart failure was more common in young women smokers (11.3%). Older women smokers had the greatest risk of heart failure as the first cardiac event.

A fatal cardiac event may be the first presentation of CVD in many individuals, as illustrated in this study, which gives credence to the considerable evidence linking smoking with CVD. It becomes absolutely imperative to reinforce this message across to the general public. Smokers, especially young smokers, should be encouraged to quit to improve their heart health. Smoking cessation counselling should be available to them. This study therefore should also act as an incentive for quitting smoking.

Reference

1. Khan SS, et al. Cigarette smoking and competing risks for fatal and nonfatal cardiovascular disease subtypes across the life course. J Am Heart Assoc. 2021 Nov 17;e021751. doi: 10.1161/JAHA.121.021751.