Elsevier

American Heart Journal

Volume 156, Issue 6, December 2008, Pages 1163-1169
American Heart Journal

Clinical Investigation
Electrophysiology
Cigarette smoking and risk of atrial fibrillation: The Rotterdam Study

https://doi.org/10.1016/j.ahj.2008.08.003Get rights and content

Background

Cigarette smoking is an important risk factor for cardiovascular disease, but it is unknown whether it also contributes to the risk of atrial fibrillation.

Methods and results

The study is part of the Rotterdam Study, a population-based cohort study among subjects aged ≥55 years. The association between cigarette smoking and the risk of atrial fibrillation was examined in 5,668 subjects without atrial fibrillation at baseline. During a median follow-up of 7.2 years, 371 cases of atrial fibrillation were identified. Relative risks (RR) were calculated with 95% CIs using the Cox proportional hazards model, adjusted for age, gender, body mass index, hypertension, systolic blood pressure, serum cholesterol level, diabetes mellitus, left ventricular hypertrophy on the electrocardiogram, prevalent and incident myocardial infarction, prevalent heart failure, and the use of pulmonary medication.

After multivariate adjustment, current smokers and former smokers had increased risks of atrial fibrillation as compared to never smokers (RR 1.51, 95% CI 1.07-2.12; and RR 1.49, 95% CI 1.14-1.97, respectively). No differences were found between men and women.

Conclusions

The results of this prospective, population-based study show that current and former smoking of cigarettes are associated with increased risk of atrial fibrillation.

Section snippets

Study population

The Rotterdam Study is a prospective population-based cohort study aimed at assessing the occurrence and progression of and risk factors for chronic diseases in the elderly. Neurogeriatric, cardiovascular, locomotor, and ophthalmologic diseases are the main areas of interest.19 All residents of the Rotterdam suburb of Ommoord, aged ≥55 years, were invited to participate. Of the 10,275 eligible individuals, 7,983 (78%) responded. Between 1990 and 1993, participants were interviewed at their home

Results

The baseline characteristics are presented in Table I. Those who had never smoked (n = 2,229) were in general slightly older than former smokers (n = 2,159) and considerably older than current smokers (n = 1,280). Never smokers consisted almost entirely of women (90.7%). Current smokers had been smoking a median number of 45 years (range 4-85 years). The median number of cigarettes per day in this group was 15 (range 1-50 cigarettes). Corresponding numbers for former smokers were 28 years

Discussion

In this prospective, population-based study, both current and former smoking were associated with risk of atrial fibrillation. The results were independent of a history of myocardial infarction at baseline and myocardial infarction occurring during follow-up. The results were also independent of pulmonary disease at baseline.

Among current smokers, no dose-response relationship could be observed between measures of duration of smoking and amount of smoking and the risk of developing atrial

Conclusion

The results of this prospective, population-based study indicate that smoking is associated with an increased risk of atrial fibrillation. Former smoking is an equally strong risk factor as current smoking.

References (33)

  • de BruyneM.C. et al.

    Diagnostic interpretation of electrocardiograms in population-based research: computer program research physicians, or cardiologists?

    J Clin Epidemiol

    (1997)
  • ZevinS. et al.

    Cardiovascular effects of carbon monoxide and cigarette smoking

    J Am Coll Cardiol

    (2001)
  • The Health Benefits of Smoking Cessation

    U.S. Department of Health and Human Services. Public Health Service. Centers for Disease Control. Center for Chronic Disease Prevention and Health Promotion. Office on Smoking and Health. DHHS publication No.( CDC) 90-8416; 1990

  • DollR. et al.

    Mortality in relation to smoking: 20 years' observations on male British doctors

    Br Med J

    (1976)
  • EscobedoL.G. et al.

    Comparison of sudden and nonsudden coronary deaths in the United States

    Circulation

    (1996)
  • BenowitzN.L.

    Drug therapy. Pharmacologic aspects of cigarette smoking and nicotine addition

    N Engl J Med

    (1988)
  • Cited by (160)

    • Aging and atrial fibrillation: A vicious circle

      2024, International Journal of Cardiology
    • Social Risk Factors and Atrial Fibrillation

      2021, Cardiac Electrophysiology Clinics
    View all citing articles on Scopus
    View full text