Cigarette Smoking Raises Heart Failure Risk in African-Americans

by Anne Harding

Cigarette smoking sharply increases the risk of heart failure in black men and women in the U.S., according to a new study by senior author, Dr. Michael E. Hall, an associate professor of medicine at the University of Mississippi Medical Center in Jackson.

“These findings suggest if you have heart failure or you have risk factors for heart failure such as early markers for heart damage like a thicker heart or a weak heart, you should specifically be targeted for smoking cessation strategies,” said the study’s senior author Dr. Hall.

In heart failure, the muscles of the heart weaken and enlarge so the organ can no longer pump blood efficiently, leading to shortness of breath and water retention. Heart failure is most often the result of damage from coronary artery disease, a buildup of fatty material within the heart arteries associated with heart attack and stroke. High blood pressure, excess weight, infection and several other factors can also contribute to heart failure.

Cigarette smoking is clearly associated with coronary artery disease, but its relationship with heart failure is not as well known, especially among African Americans, Hall’s team writes in the journal Circulation.

Blacks in the U.S. have double the incidence of heart failure as other groups, the researchers note. While smoking in this community has declined, it is still at 18 percent of adults, they add.

To investigate the potential role of smoking in heart failure risk, the researchers analyzed data on 4,129 black adults in Mississippi who participated in the Jackson Heart Study. Their average age was 54, and all were free of heart disease when they enrolled. Twelve percent reported being smokers, 18 percent were ex-smokers and 70 percent had never smoked.

Compared to never-smokers, the smokers had more enlargement of the left ventricle, the heart’s main pumping chamber, and worse left ventricular function. Levels of a hormone released by the heart that indicates heart failure, called brain natriuretic peptide (BNP), were higher in smokers than never-smokers, and those levels increased with the intensity and duration of smoking.

Once the authors took factors associated with both smoking and heart failure, such as coronary artery disease, into account, they found that smokers were almost three times more likely than non-smokers to be hospitalized for heart failure during eight years of follow-up.

People who smoked at least 20 cigarettes a day saw their risk increase about 3.5-fold. Those who had smoked the equivalent of a pack or more a day for 15 or more years were twice as likely as never-smokers to be hospitalized for heart failure.

Physicians will typically ask patients with coronary artery disease about smoking, and urge them to quit if they do, Hall said in a telephone interview. But heart failure seems to be a less obvious cue to many doctors.

“We probably in the health community need to do a better job of recommending cessation strategies for people who have risk factors for heart failure,” Hall said. “If they have risk factors, they should be strongly counseled to quit, that should be a no-brainer.”

He acknowledged that lack of health insurance and other factors can be barriers to effective smoking cessation treatment. But the costs of drugs proven to help people quit have declined, Hall noted, and many are now available for less than a pack-a-day smoker spends in a month on cigarettes.

In future research, he and his colleagues plan to examine whether newer nicotine delivery devices, like e-cigarettes, have similar effects on the heart.