Jung Eun Yoo MD, PhD ^a, Su-Min Jeong MD ^b, Yohwan Yeo MD ^b, Wonyoung Jung MD ^b, Juhwan Yoo BS ^c, Kyungdo Han PhD ^d, Cheol Min Lee MD, PhD ^a, Jin Ho Park MD, PhD ^e, Kyung Woo Park MD, PhD ^f,g, Dong Wook Shin MD, MBA, DrPH ^b,h

^aDepartment of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
^bDepartment of Family Medicine, Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
^cDepartment of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Republic of Korea
^dDepartment of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
^eDepartment of Family Medicine, Seoul National University Hospital, Seoul, Seoul National University College of Medicine, Seoul, Republic of Korea
^fDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
^gDivision of Cardiology, Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
^hDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea

Address for correspondence: Prof Dong Wook Shin

Background: There is a lack of data for the incidence of heart failure (HF) according to changes in smoking behaviors.

Objectives: The authors aimed to investigate the effects of smoking behavior change on development of HF.

Methods: In this population-based, retrospective cohort study using the Korean National Health Insurance System database, the authors identified 778,608 current smokers who participated in a health screening program in 2009 and in a follow-up screening in 2011. Participants were categorized into quitters, reducers I (≥50% reduction) and II (<50% reduction), sustainers, and increasers.

Results: During a median follow-up of 6.3 years, there were 23,329 HF events (4.8 per 1,000 person-years). Compared with sustainers, the risk of HF was increased among increasers (adjusted hazard ratio [aHR]: 1.06 [95% CI: 1.02-1.10]). By contrast, quitters had a reduced risk for HF (aHR: 0.86 [95% CI: 0.83-0.90]). Even heavy smokers who quit smoking had a lower risk for HF than those who sustained heavy smoking (aHR: 0.90 [95% CI: 0.85-0.95]). In reducers, the risk of HF was not reduced but rather increased slightly (≥50% reduction, aHR: 1.06 [95% CI: 1.01-1.11]; <50% reduction, aHR: 1.04 [95% CI: 1.00-1.08]).

Conclusions: Current smokers who increased their smoking amount were associated with a higher risk for HF development compared to sustainers, whereas self-reported smoking cessation was associated with a lower risk of HF. There was no benefit from reduction in smoking amount. Self-reported smoking cessation should be reinforced whenever possible to prevent HF.