Highlights
- •Smoking is associated with a modest increased risk of atrial fibrillation (AF).
- •Quitting smoking seemed to reduce, but not entirely eliminate, the excess risk of AF.
- •6.7% of total risk of AF in men and 1.4% in women were attributable to smoking.
Abstract
Background
Several studies have investigated the role of smoking in incident atrial fibrillation
(AF) but have reported contradictory results. Identifying the quantitative association
between smoking and AF risk is important for AF management and prevention; therefore,
we aimed to estimate the association of smoking with incident AF.
Methods
We systematically retrieved relevant studies reporting on the association between
smoking and AF using the Cochrane Library, PubMed, and Embase databases. The data
were extracted from applicable articles, and we used a random effects model to pool
the effect estimates.
Results
Sixteen prospective studies with an overall number of 286,217 participants and 11,878
AF cases met the inclusion criteria. A higher prevalence of AF was confirmed among
smokers (risk ratio [RR] = 1.23, 95% confidence interval [CI] 1.08–1.39; P = 0.001). These results were stable in the sensitivity analysis. The pooled RRs showed
consistent positive associations in most subgroups. Specifically, 8 articles compared
both current smokers (RR = 1.39, 95% CI 1.11–1.75) and former smokers (RR = 1.16, 95% CI: 1.00–1.36) with never smokers. Four articles compared ever smokers (pooled
RR = 1.21, 95% CI 0.93–1.57) with never smokers, and 7 articles compared current smokers
(pooled RR = 1.21, 95% CI 1.03–1.42) with non-current smokers. Additionally, we estimated that
6.7% of the total risk of AF in men and 1.4% of the risk in women were attributable
to smoking worldwide.
Conclusions
Based on the published literature, smoking is associated with a modest increased risk
of incident AF. Smoking cessation seemed to reduce but not entirely eliminate the
excess risk of AF.
Keywords
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Article info
Publication history
Published online: May 13, 2016
Accepted:
May 12,
2016
Received in revised form:
April 15,
2016
Received:
March 6,
2016
Footnotes
☆Funding: The authors wish to acknowledge support from the National Natural Science Foundation of China (8153000545, 81530013, 81370288) and the National Basic Research Program of China (973 Program: 2013CB531103).
Identification
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