Smoking and risk of atrial fibrillation in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

Academic Article


  • BACKGROUND: Whether smoking increases the risk of atrial fibrillation (AF) remains debatable due to inconsistent reports. METHODS: We examined the association between smoking and incident AF in 11,047 participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, one of the largest biracial, population-based cohort studies in the USA. Baseline (2003-2007) cigarette smoking status and amount (pack-years) were self-reported. Incident AF was determined by electrocardiography and history of a prior physician diagnosis at a follow-up examination conducted after a median of 10.6 years. RESULTS: During follow-up, 954 incident AF cases were identified; 9.5% in smokers vs. 7.8% in non-smokers; p<0.001. In a model adjusted for socio-demographics, smoking (ever vs. never) was associated with a 15% increased risk of AF [OR (95%CI): 1.15(1.00, 1.31)], but this association was no longer significant after further adjustment for cardiovascular risk factors [OR (95% CI): 1.12 (0.97, 1.29)]. However, heterogeneities in the association were observed among subgroups; the association was stronger in young vs. old participants [OR (95%CI): 1.31 (1.03, 1.67) vs. 0.99 (0.83-1.18) respectively; interaction p-value=0.005] and in those with vs. without prior cardiovascular disease [OR (95%CI): 1.18 (0.90, 1.56) vs. 1.06 (0.90, 1.25) respectively; interaction p-value 0.0307]. Also, the association was significant in blacks but not in whites [OR (95%CI): 1.51 (1.12, 2.05) vs. 0.99 (0.84, 1.16), respectively], but the interaction p-value did not reach statistical significance (interaction p-value=0.65). CONCLUSIONS: The association between smoking and AF is possibly mediated by a higher prevalence of cardiovascular risk factors in smokers, but there is marked heterogeneity in the strength of this association among subgroups which may explain the conflicting results in prior studies.
  • Published In


  • Atrial fibrillation, REGARDS study, Smoking, African Continental Ancestry Group, Aged, Atrial Fibrillation, Cohort Studies, Electrocardiography, Female, Humans, Male, Middle Aged, Prevalence, Risk Factors, Smoking
  • Digital Object Identifier (doi)

    Author List

  • Imtiaz Ahmad M; Mosley CD; O'Neal WT; Judd SE; McClure LA; Howard VJ; Howard G; Soliman EZ
  • Start Page

  • 113
  • End Page

  • 117
  • Volume

  • 71
  • Issue

  • 2