Smoking Cessation Reduces the Risk of Heart Failure: A Nationwide Cohort Study
Authors and Affiliations
Authors and Affiliations
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.