Abstract 15464: Differential Effects of Smoking on Specific Cardiovascular Presentations in Men and Women: Prospective Cohort Study in 900,000 Patients Using CALIBER Linked Electronic Health Records

Abstract

Background: It is not known whether the risk of smoking differs across a range of specific cardiovascular presentations because previous studies have been too small or evaluated a limited number of phenotypes.

Objective: To investigate the association between smoking and 8 different initial presentations of cardiovascular disease.

Methods: Prospective cohort study of ∼900,000 adults with median observation time of 4.5 years and 51,551 initial presentation events (non-fatal and fatal) shown in the Figure below. We used electronic health records from primary and secondary care, linked with a national acute coronary syndrome registry and mortality data. The hazard of smoking was modeled using Cox proportional hazard regression with competing risks, adjusted for age, social deprivation, blood pressure, blood pressure lowering medication, statin use and diabetes.

Results: Current smoking was not associated with initial presentation of ventricular arrhythmias/cardiac arrest. Amongst the other cardiac presentations, there was a clear gradient with weak associations with initial onset stable angina, moderate with unstable angina and heart failure, and strong with myocardial infarction (MI) and coronary death unheralded by prior symptomatic disease. There was evidence of greater hazard of smoking for PAD in men (HR 3.67 (95% CI 3.42-3.94) compared to women (HR 2.79 (2.61-2.97)) but lower hazard for acute MI (HR in men: 2.16 (2.00-2.32); HR in women: 2.58 (2.35-2.82)).

Conclusion: The association of smoking with specific cardiovascular presentations varies considerably, being absent for ventricular arrhythmias, modest for chronic presentations of cardiac disease and greatest for the more acute cardiac presentations. Gender differences, in opposing directions, are limited to PAD and acute MI.