African-American adults who smoke are at higher risk of being hospitalized with heart failure than those who used to smoke or have never smoked, a new study shows.
For people who smoke, the results “should add more fuel to the discussion” about quitting, said the study’s senior author Dr. Michael E. Hall, a cardiologist at the University of Mississippi Medical Center in Jackson.
Cigarette smoking increases the risk for different types of heart problems. The new study published Monday in Circulation suggests that smoking may help explain why African-Americans are at higher risk than white people of developing heart failure, a condition that occurs when the heart is weakened and cannot properly pump blood.
For the study, Hall and his colleagues analyzed data collected over eight years from 4,129 people taking part in the Jackson Heart Study, a long-running study of risk factors for heart disease in African-Americans. None of the study participants had been diagnosed with heart disease or stroke when the study started. Among the group, 2,884 had never smoked; 503 were current smokers and 742 were former smokers.
Studies have shown smokers are more likely than nonsmokers to develop atherosclerosis — clogs in the arteries. The new findings suggest smoking may also contribute to thickening and weakening of the left side of the heart, which pumps blood out to the rest of the body.
About 16.5 percent of African-American adults are current smokers, according to data from the Centers for Disease Control and Prevention. African-Americans also are disproportionately affected by obesity and high blood pressure, two of the main risk factors for heart failure.
Previous studies have identified a higher risk for heart failure among African-Americans. In 2008, findings from the Multi-Ethnic Study of Atherosclerosis showed African-Americans were at higher risk than white, Hispanic and Chinese Americans. In older black men, risk increases with age, according to national heart disease and stroke statistics.
Dr. Emer Joyce, a heart failure specialist at the Cleveland Clinic who was not involved in the new study, said although the strong association between smoking and heart failure was notable in the study participants, more research is needed to establish a direct link between smoking and heart failure and to explain how smoking causes the structural and functional damage that is characteristic of heart failure.
The researchers said the findings could lead family medicine doctors, cardiologists and other physicians to more aggressively encourage patients who smoke to kick the habit.
“We often have triggers for what we counsel for,” said Hall. Smoking is a catalyst to talk about heart disease, he said, but doctors may less frequently discuss heart failure, “because we don’t have as much data showing that [smoking] directly causes heart failure.”
Joyce said public health officials can use the findings to inform future educational campaigns. She suggested that those initiatives could show that beyond causing lung problems and lung cancer, smoking can also lead to stroke, coronary artery disease, heart attacks and heart failure.