Environmental Tobacco Smoke and Atrial Fibrillation

O’Neal, Wesley T.; Qureshi, Waqas; Judd, Suzanne E.; McClure, Leslie A.; Cushman, Mary; Howard, Virginia J.; Howard, George; Soliman, Elsayed Z

doi:10.1097/jom.0000000000000565

Cited by 14 publications

(4 citation statements)

References 26 publications

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“…This finding is supported by a prior report form REGARDS which demonstrated that environmental tobacco smoke is more strongly associated with AF in blacks than whites [27]. Potentially, racial differences in susceptibility to tobacco smoke explain this finding, as black patients with chronic obstructive pulmonary disease have been reported to lose more lung function per pack-year compared with whites [26].…”

Section: Discussionsupporting

confidence: 69%

Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

O’Neal

Judd

Limdi

et al. 2016

J. Racial and Ethnic Health Disparities

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Background Despite a higher prevalence of risk factors, atrial fibrillation (AF) is less prevalent in blacks than whites. To address this paradox, we examined racial differences in the magnitude of AF risk associated with common risk factors. Methods 13,688 participants (mean age=63±8.4 years; 56% female; 37% black) from the REasons for Geographic And Racial Differences in Stroke study who were free of baseline AF were included. Incident AF was identified at a follow-up examination by electrocardiogram and self-reported medical history. Poisson regression was used to compute relative risk (RR) and 95% confidence intervals (CI) for the association between risk factors and incident AF in blacks and whites, separately. Age- and sex-adjusted population attributable fractions (PAF) of modifiable AF risk factors were computed. Results After median follow-up of 9.4 years, 997 (7.3%) incident AF cases were detected. Black race was associated with a lower risk of AF (RR=0.46, 95%CI=0.39, 0.53). Significant risk factors for AF were age, male sex, hypertension, obesity, and cardiovascular disease. A differential association was detected for smoking by race, with the association being stronger in blacks (RR=1.41, 95%CI=1.07, 1.85) compared with whites (RR=1.01, 95%CI=0.88, 1.16; p-interaction=0.030). The PAFs for hypertension (blacks=27.4%; whites=19.4%), obesity (blacks=16.9%; whites=11.8%), and smoking (blacks=17.9%; whites=2.5%) were higher for blacks than whites. Conclusion Modifiable risk factors are important in AF development among blacks despite a lower risk of the arrhythmia. Racial differences in the magnitude of the association of individual AF risk factors do not explain the AF paradox.

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Section: Discussionsupporting

confidence: 69%

Differential Impact of Risk Factors in Blacks and Whites in the Development of Atrial Fibrillation: the Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study

O’Neal

Judd

Limdi

et al. 2016

J. Racial and Ethnic Health Disparities

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“…104 Exposure during gestational development or early childhood is associated with approximately 40% increased risk of AF. 105 …”

Section: Risk Factors For Developing Afmentioning

confidence: 99%

Atrial Fibrillation

Stærk

Sherer

et al. 2017

Circulation Research

900

380

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The last three decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported seventeen independent signals for AF at fourteen genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors, including sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF and each factor has been shown to induce structural and electrical remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.

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“…121 In another study, AF risk was associated with the environmental tobacco use. 124 There have also been case reports of AF associated with chewing nicotine gum. 125–127 In contrast, a pooled analysis of Swedish studies found current use of snus, a powdered smokeless tobacco product, was not significantly associated with incident AF (RR, 1.07; 0.97–1.19).…”

Section: Introductionmentioning

confidence: 99%