Tobacco smoking and the risk of atrial fibrillation: a systematic review and meta-analysis of prospective studies
File(s)180712 DagfinnAune Eur J Prev Card.doc (1.57 MB)
Accepted version
Author(s)
Aune, Dagfinn
Schlesinger, Sabrina
Norat, Teresa
Riboli, Elio
Type
Journal Article
Abstract
Background Epidemiological studies on smoking and atrial fibrillation have been inconsistent, with some studies showing a positive association while others have found no association. It is also unclear whether there is a dose-response relationship between the number of cigarettes smoked or pack-years and the risk of atrial fibrillation. We conducted a systematic review and meta-analysis to clarify the association. Design Systematic review and meta-analysis. Methods We searched the PubMed and Embase databases for studies of smoking and atrial fibrillation up to 20 July 2017. Prospective studies and nested case-control studies within cohort studies reporting adjusted relative risk estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with smoking were included. Summary relative risks (95% CIs) were estimated using a random effects model. Results Twenty nine prospective studies (22 publications) were included. The summary relative risk was 1.32 (95% CI 1.12-1.56, I2 = 84%, n = 11 studies) for current smokers, 1.09 (95% CI 1.00-1.18, I2 = 33%, n = 9) for former smokers and 1.21 (95% CI 1.12-1.31, I2 = 80%, n = 14) for ever smokers compared to never smokers. Comparing current versus non-current smokers the summary relative risk was 1.33 (95% CI 1.14-1.56, I2 = 78%, n = 10). The summary relative risk was 1.14 (95% CI 1.10-1.20, I2 = 0%, n = 3) per 10 cigarettes per day and 1.16 (95% CI 1.09-1.25, I2 = 49%, n = 2) per 10 pack-years and there was no evidence of a non-linear association for cigarettes per day, Pnon-linearity = 0.17. Conclusions The current meta-analysis suggests that smoking is associated with an increased risk of atrial fibrillation in a dose-dependent matter, but the association is weaker among former smokers compared to current smokers.
Date Issued
2018-09-01
Date Acceptance
2018-05-13
Citation
European Journal of Preventive Cardiology, 2018, 25 (13), pp.1437-1451
ISSN
2047-4873
Publisher
SAGE Publications
Start Page
1437
End Page
1451
Journal / Book Title
European Journal of Preventive Cardiology
Volume
25
Issue
13
Copyright Statement
© 2018 The European Society of Cardiology. The final, definitive version of this paper has been published in Aune, D., Schlesinger, S., Norat, T., & Riboli, E. (2018). Tobacco smoking and the risk of atrial fibrillation: A systematic review and meta-analysis of prospective studies. European Journal of Preventive Cardiology, 25(13), 1437–1451 by Sage Publications Ltd. All rights reserved. It is available at: https://dx.doi.org/10.1177/2047487318780435
Sponsor
Imperial College Trust
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29996680
Grant Number
P47328
Subjects
Tobacco
atrial fibrillation
cigarettes
meta-analysis
smoking
systematic review
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-07-11