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Smoking, plasma cotinine and risk of atrial fibrillation: the Hordaland Health Study
Author(s) -
Zuo H.,
Nygård O.,
Vollset S. E.,
Ueland P. M.,
Ulvik A.,
Midttun Ø.,
Meyer K.,
Igland J.,
Sulo G.,
Tell G. S.
Publication year - 2018
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12689
Subject(s) - medicine , cotinine , prospective cohort study , body mass index , atrial fibrillation , risk factor , nicotine
Background Cigarette smoking has been identified as a major modifiable risk factor for coronary heart disease and mortality. However, findings on the relationship between smoking and atrial fibrillation ( AF ) have been inconsistent. Furthermore, findings from previous studies were based on self‐reported smoking. Objective To examine the associations of smoking status and plasma cotinine levels, a marker of nicotine exposure, with risk of incident AF in the Hordaland Health Study. Methods We conducted a prospective analysis of 6682 adults aged 46‐74 years without known AF at baseline. Participants were followed via linkage to the Cardiovascular Disease in Norway ( CVDNOR ) project and the Cause of Death Registry. Smoking status was assessed by both questionnaire and plasma cotinine levels. Results A total of 538 participants developed AF over a median follow‐up period of 11 years. Using questionnaire data, current smoking ( HR : 1.41, 95% CI : 1.09–1.83), but not former smoking ( HR : 1.03, 95% CI : 0.83–1.28), was associated with an increased risk of AF after adjustment for gender, age, body mass index, hypertension, physical activity and education. Using plasma cotinine only, the adjusted HR (95% CI ) was 1.40 (1.12–1.75) for participants with cotinine ≥85 nmol L −1 compared to those with cotinine <85 nmol L −1 . However, the risk increased with elevated plasma cotinine levels until 1199 nmol L −1 ( HR : 1.55, 95% CI : 1.16–2.05 at the third group vs. the reference group) and plateaued at higher levels. Conclusions Current, but not former smokers, had a higher risk of developing AF . Use of plasma cotinine measurement corroborated this finding.