ESC Congress 2020: Smoking cessation linked to reduced stroke risk in AF patients

So-Ryoung Lee

Research presented at the ESC Congress 2020 (Virtual, 29 August–1 September) suggests that, among atrial fibrillation (AF) patients, those who quit smoking were 30% less likely to suffer a stroke than those who continue to smoke.

Previous studies have shown that smokers are more likely to develop AF and subsequent stroke. While many strokes are prevented with oral anticoagulant drugs, there are limited data on the impact of smoking cessation after AF diagnosis.

The present study, authored by So-Ryoung Lee (Seoul National University Hospital, Seoul, Korea), examined the association between smoking cessation after newly diagnosed AF and the risks of stroke and all-cause death. Researchers used the Korean National Health Insurance Service database and the National Health Screening database. Koreans aged 40 and older are advised to have a national health check-up every two years.

The researchers identified 523,174 patients with newly diagnosed AF in 2010 to 2016. Patients with prior strokes were excluded. The study included the 97,637 patients who had a national health check-up less than two years before being diagnosed with AF, and a second check-up within two years afterwards. Patients were followed-up after the second check-up until the end of 2017 for the occurrence of stroke or death.

The average age was 61 years and 62% were men. Participants were classified according to smoking status before and after AF diagnosis: never-smoker, ex-smoker (stopped smoking before diagnosis), quitter (stopped smoking after diagnosis), current smoker (includes those who persistently smoked before and after diagnosis; and new smokers who started after the diagnosis). The proportions of never smokers, ex-smokers, quitters, and current smokers were 51.2%, 27.3%, 6.9%, and 14.6%, respectively.

During a median three-year follow-up, there were 3,109 strokes and 4,882 all-cause deaths (10 per 1,000 person-years and 15.4 per 1,000 person-years, respectively).

Compared to current smokers, quitters had a 30% lower probability of stroke and 16% reduced likelihood of all-cause death, after accounting for other factors that could influence the relationships such as age, sex, high blood pressure, body mass index, and physical activity.

Quitters remained at higher risk compared with never-smokers. The risks of stroke and all-cause death were raised by 19% and 46%, respectively, but these associations were consistently observed only in men. New and persistent smokers had even greater risks of stroke compared to those who had never smoked. For new smokers, the probability was raised by 84% and for persistent smokers it was elevated by 66%.

Commenting on the findings, So-Ryoung Lee said: “Smoking precipitates blood clots that could lead to a stroke, which may be why giving up lowers risk. The remaining stroke risk after quitting might be through the damage already caused to the arteries—called atherosclerosis.”

She noted that the benefits of quitting were less pronounced in those who had been heavy smokers before their atrial fibrillation diagnosis. Heavy smokers were defined as those who had smoked 20 cigarettes every day for at least 30 years. “This may be related to longer-term damage to the blood vessels which increases susceptibility to having a stroke,” said Lee.

Lee said: ”If you don’t smoke, don’t start. If you do, it’s never too late to quit. Regardless of how much you smoke, kicking the habit is good for health.”


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