Physicians' Academy for Cardiovascular Education

Smoking and its cessation similarly associated with HFpEF and HFrEF

Cigarette Smoking, Cessation, and Risk of Heart Failure With Preserved and Reduced Ejection Fraction

Literature - Ding N, Shah AM, Blaha MJ, et al. - J Am Coll Cardiol. 2022 Jun;79(23):2298-2305. doi: 10.1016/j.jacc.2022.03.377

Introduction and methods


Smoking is an important modifiable risk factor for HF and the percentage of HF attributable to smoking is 14% [1]. Recent systematic reviews have shown that current and former smokers have an increased risk of HF [2,3]. However, few studies have studied the association between smoking and smoking cessation with the incidence of the 2 phenotypes of HF: HFrEF and HFpEF [4-8]. Moreover, these studies have shown conflicting results.

Aim of the study

The aim of this study was to investigate the association of cigarette smoking and smoking cessation with the incidence of HF, overall and for HFrEF and HFpEF separately.


The researchers used data from a prospective cohort consisting of 15,792 Americans aged 45-64 years from 4 communities (ARIC study). For this substudy, data were analyzed from 9345 participants who were alive in early 2005, had no HF, and whose follow-up data were available with no missing values. Information on smoking (smoking status, number of pack years, intensity, duration, and number of years since cessation) was limited to cigarette smoking and was obtained during 7 visits to the study center and through (semi-)annual telephone interviews during the period 1987-2019. Median follow-up was 13.0 years.


Definite and probable cases of acute decompensated HF were identified on the basis of medical records. The phenotypes of HF – HFrEF and HFpEF – were classified according to LVEF (LVEF < 50% or ≥ 50%, respectively).

Main results


All parameters of cigarette smoking consistently showed statistically significant and similar associations with HFrEF and HFpEF. Smoking cessation substantially reduced the risk of HF, but an increased risk of HF persisted for several decades. The results highlight that smoking is an important modifiable risk factor for HF and that smoking prevention and cessation are important to prevent HF.


Show references

Find this article online at J Am Coll Cardiol.

Share this page with your colleagues and friends: