Monday, August 29, 2022

Smoking is even more damaging to the heart than previously thought

Reports and Proceedings

EUROPEAN SOCIETY OF CARDIOLOGY

Barcelona, Spain – 25 Aug 2022: Smokers have weaker hearts than non-smokers, according to research presented at ESC Congress 2022.1 The study found that the more people smoked, the worse their heart function became. Some function was restored when people kicked the habit.

“It is well known that smoking causes blocked arteries, leading to coronary heart disease and stroke,” said study author Dr. Eva Holt of Herlev and Gentofte Hospital, Copenhagen, Denmark. “Our study shows that smoking also leads to thicker, weaker hearts. It means that smokers have a smaller volume of blood in the left heart chamber and less power to pump it out to the rest of the body. The more you smoke, the worse your heart function becomes. The heart can recuperate to some degree with smoking cessation, so it is never too late to quit.”

According to the World Health Organization, tobacco kills more than eight million people each year.2 Cigarette smoking is responsible for 50% of all avoidable deaths in smokers, with half of these due to atherosclerotic cardiovascular diseases such as heart attack and stroke.3 The detrimental effects of smoking on the arteries and arterial diseases such as heart attack and stroke are well established.4

Studies have also shown that smoking is associated with a higher risk of heart failure, where the heart muscle does not pump blood around the body as well as it should, usually because it is too weak or stiff. This means that the body does not receive the oxygen and nutrients it needs to work normally. The link between smoking and heart structure and function has not been fully examined. This study therefore explored whether smoking was related to changes in the structure and function of the heart in people without cardiovascular disease, and the effect of changing smoking habits.

The study used data from the 5th Copenhagen City Heart Study which investigated cardiovascular risk factors and diseases in the general population. A total of 3,874 participants aged 20 to 99 years without heart disease were enrolled. A self-administered questionnaire was used to obtain information on smoking history and to estimate pack-years, which is the number of cigarettes smoked through life. One pack-year is defined as 20 cigarettes smoked every day for one year.

Participants had an ultrasound of the heart, called echocardiography, which provides information about its structure and how well it is working. The researchers compared the echocardiography measures of current smokers versus never smokers after adjusting for age, sex, body mass index, hypertension, high cholesterol, diabetes and lung function.

The average age of participants was 56 years and 43% were women. Nearly one in five participants were current smokers (18.6%), while 40.9% were former smokers and 40.5% had never smoked. Compared to never smokers, current smokers had thicker, weaker and heavier hearts. Increasing pack-years were associated with pumping less blood. Dr. Holt explained: “We found that current smoking and accumulated pack-years were associated with worsening of the structure and function of the left heart chamber – the most important part of the heart. Furthermore, we found that over a 10-year period, those who continued smoking developed thicker, heavier and weaker hearts that were less able to pump blood compared to never smokers and those who quit during that time.”

She concluded: “Our study indicates that smoking not only damages the blood vessels but also directly harms the heart. The good news is that some of the damage is reversible by giving up.”

 

ENDS

 

Notes to editors

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Funding: The Copenhagen City Heart Study is funded by The Danish Heart Foundation and The Metropolitan Region of Denmark.

 

Disclosures: Tor Biering-Sørensen reports: Steering Committee member of the Amgen financed GALACTIC-HF trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “NUDGE- FLU” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-1” trial. Chief investigator and steering committee chair of the Sanofi Pasteur financed “DANFLU-2” trial. Steering Committee member of “LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific's Investigational ICM System” trial. Advisory Board: Sanofi Pasteur, Amgen and GSK. Speaker Honorarium: Novartis, Sanofi Pasteur and GSK. Research grants: GE Healthcare and Sanofi Pasteur. The remaining authors have nothing to disclose.

 

References and notes

1The abstract “The effects of smoking on cardiac structure and function in a general population” will be presented during the session Risk stratification with echocardiographic parameters on Friday 26 August at 10:15 to 11:00 CEST at Station 1.

2World Health Organization tobacco fact sheet: https://www.who.int/news-room/fact-sheets/detail/tobacco.

3Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42:3227–3337.

4Centers for Disease Control and Prevention smoking and cardiovascular disease fact sheet: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf.

 

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2022

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Barcelona and online – from 26 to 29 August. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.


Public call for tougher restrictions on buying tobacco in Britain


Peer-Reviewed Publication

UNIVERSITY COLLEGE LONDON

People in Britain strongly support restricting the sale of tobacco near schools and raising the legal age of sale to 21, finds a new UCL-led study.

In collaboration with The University of Edinburgh and Cardiff University, the research, published in Tobacco Control, examined data from the Cancer Research UK and SPECTRUM*-funded Smoking Toolkit Study, which has surveyed approximately 1,700 adults each month from England since 2006, and 2,200 adults each month from England, Scotland and Wales, since 2020.

The researchers examined data from September 2021, which asked participants about their views on potential policies targeting the availability of tobacco and cigarettes.

The results indicated that most of those surveyed supported retailers having their license revoked if they sold tobacco products to those under-age (89.6%) and for restrictions on the sale of cigarettes and tobacco near schools (69.9%).

Meanwhile, half (49.2%) thought that the legal age of sale for cigarettes and tobacco should be raised to 21, compared with just under a third who were opposed to the idea (30.7%).

Participants were also in favour of reducing the number of retailers selling tobacco in neighbourhoods that already had a high density of tobacco retailers – with almost half (46.5%) showing their support, compared with less than a quarter (23.3%) who disagreed.

Lead author Dr Loren Kock (UCL Institute of Epidemiology & Health) said: “Our findings indicate that policies to restrict tobacco retail near schools, and for tobacco retailer licences would receive strong majority support from the British public if legislated.

“Raising the age of sale to 21 and reducing the number of tobacco retailers also received greater support than opposition.

“However, a substantial proportion of respondents report having no opinion either way on these policies, suggesting there is potential to grow public support through clearer communication on the evidence and benefits of these policies.

“Moreover, support for tobacco availability policy may grow, and opposition diminish, if policies are demonstrated to be effective, and as future generations grow up without cigarettes.”

There are around 6.9million adult cigarette smokers in the UK, who spend approximately £15.6billion a year on legal and illicit tobacco.

Currently the law prohibits the sale of tobacco products to those under the age of 18. And previous studies have shown that a ban on the sale of tobacco products near schools could stop children from taking up the habit.

In 2019, the UK Government set an objective for England to be smokefree by 2030, meaning only 5% of the population would smoke by then. However, a recent report by Dr Javed Khan OBE, highlighted that particularly poorer areas may struggle to reach this target unless the rate of decline of people who smoke is accelerated by 40% **.

Niamh Shortt, Personal Chair of Health Geographies, School of GeoSciences, University of Edinburgh, said: “Across the UK nations targets have been set to radically reduce the proportion of people that smoke over the next decade.

“This new research shows that the public strongly support the introduction of new measures needed to meet these ambitious targets, including reducing the local availability of tobacco products.

“Having wide scale public support to introduce restrictions on the sales of tobacco should embolden the UK and devolved governments to introduce new policies restricting access to tobacco, particularly amongst children, and ensure future generations are tobacco free.”

Study limitations

The use of cross-sectional observational data and potentially unmeasured covariates limits the ability to infer causality between included variables (namely sociodemographic and smoking and quitting characteristics) and support for policies. The sample sizes for the sub-group analyses in Scotland and Wales analyses may also be underpowered.

Data on support for tobacco availability were collected during one survey wave, and if further data were collected the results may change.

* SPECTRUM is a UK Prevention Research Partnership (UKPRP) consortium.

** https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete/making-smoking-obsolete-summary

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