Abstract 15612: The Impact of Smoking on Thromboembolism and Mortality in Patients with Atrial Fibrillation: The Diet, Cancer and Health Study

Abstract

Introduction Smoking and atrial fibrillation (AF) are major health problems worldwide and responsible for many health care costs.

Hypothesis Smoking is associated with a higher risk of thromboembolism (TE; ischemic stroke or arterial TE), or death among patients with incident AF.

Methods Prospective cohort study of 57,053 persons aged 50 to 64. The risk of TE or death according to smoking habits amongst 3,161 patients with incident AF (mean age 66.9 years; 2,032 men, 1,129 women) was assessed using Cox proportional hazard models. Results Of the subjects with AF 34% were current smokers and 37% former. After adjustment for vitamin K antagonist treatment the hazard ratios of TE or death was 3.13 (1.72-6.37) and 2.73 (2.02-3.70) among heavy current female and male smokers, respectively. The associations remained after adjustment for well-established risk factors with hazard ratios of 3.64 (1.88-7.07) and 2.17 (1.59-2.95) among women and men, respectively. Smoking was still highly associated with TE or death after excluding people with a cancer diagnosis during follow-up in a sensitivity analysis.

Conclusion Smoking is associated with a higher risk of TE or death in patients with AF - even after adjusting for well-recognised risk factors used in stroke risk stratification schemes. Patients with AF who smoke represent a ‘high-risk’ population which necessitates proactive management of all cardiovascular risk factors and effective oral anticoagulation to reduce the risk in these patients.