J Clin Med. 2021;10(11):jcm10112238.

Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death.

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제1저자 이소령 · 교신저자 최의근

PMID 34064089 PMC8196704 DOI 10.3390/jcm10112238 IF 3.3 순환기내과

소속 (6)

Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.
Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul 06591, Korea.
Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool L14 3PE, UK.
Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.

Abstract

Limited data are available regarding the impact of smoking cessation after atrial fibrillation (AF) diagnosis on clinical outcomes. Using the Korean National Health Insurance Service database, we included patients newly diagnosed with AF and categorized them into four groups as follows: (i) never smokers, (ii) ex-smokers, (iii) smoking cessation after AF diagnosis ("quitters"), and (iv) current smokers. The primary outcomes were incident ischemic stroke and all-cause death during follow-up. Fatal ischemic stroke and death from cerebrovascular events were evaluated as secondary outcomes. Among 97,637 patients (mean age, 61 years; mean CHA₂DS₂-VASc score, 2.3), 6.9% stopped smoking after AF diagnosis. The mean follow-up duration was 3.2 ± 2.0 years. After multivariable adjustment, quitters had lower risks of ischemic stroke (hazard ratio (HR), 0.702; 95% confidence interval (CI), 0.595-0.827) and all-cause death (HR, 0.842; 95% CI, 0.748-0.948) than current smokers. Quitters after AF diagnosis were associated with lower risks of fatal ischemic stroke (HR, 0.454; 95% CI, 0.287-0.718) and death from cerebrovascular events (HR, 0.664; 95% CI, 0.465-0.949) compared with current smokers. Quitting smoking may reduce the risk of ischemic stroke, the severity of ischemic stroke, and the incidence of cerebrovascular events in patients with new-onset AF.

Keywords

atrial fibrillationdeathsmokingstroke

Figures

**Figure 1** Study design. AF: Atrial fibrillation.

**Figure 2** Study enrollment flow. AF: Atrial fibrillation.

**Figure 3** Hazard ratios of smoking status on the risk of ischemic stroke and all-cause death. * With current smokers as the reference group; IR, per 1000 person-years. Abbreviation: CI, confidence interval; HR, hazard ratio; IR, incidence rate.

**Figure 4** Hazard ratios of smoking status on the risk of fatal ischemic stroke and fatal cerebrovascular event. * With current smokers as the reference group. IR, per 1000 person-years. Abbreviation: CI, confidence interval; HR, hazard ratio; IR, incidence rate.

**Figure 5** Hazard ratios of smoking status on the risk of ischemic stroke, fatal ischemic stroke, death from cerebrovascular events, and all-cause death according to their OAC treatment status. * With current smokers as the reference group. IR, per 1000 person-years. Abbreviation: CI, confidence interval; HR, hazard ratio; IR, incidence rate; OAC, oral anticoagulation; p int, p for interaction.

그림 출처: PubMed Central 공개 논문 (PMC8196704)

Conflict of interest statement

S.-R.L., J.-H.J., K.-D.H., and S.O.: none. E.-K.C.: research grants or speaking fees from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Dreamtech Co., Ltd., Medtronic, Samjinpharm, Sanofi-Aventis, Seers Technology, Skylabs, and Yuhan. G.Y.H.L.: consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo, but no fees were received personally.

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