Cigarette Smoking and Structural Brain Deficits in Patients With Atrial Fibrillation

Raffaele Peter; Stefanie Aeschbacher; Rebecca E Paladini; Michael Coslovsky; Philipp Krisai; Adrian Schweigler; Tobias Reichlin; Nicolas Rodondi; Andreas Müller; Moa Haller; Merit Röhl; Annina Stauber; Tim Sinnecker; Leo H Bonati; Thilo Burkard; David Conen; Stefan Osswald; Michael Kühne; Christine S Zuern

doi:10.1016/j.amjcard.2024.11.008

Cigarette Smoking and Structural Brain Deficits in Patients With Atrial Fibrillation

Am J Cardiol. 2024 Nov 21:237:72-78. doi: 10.1016/j.amjcard.2024.11.008. Online ahead of print.

Authors

Raffaele Peter¹, Stefanie Aeschbacher¹, Rebecca E Paladini¹, Michael Coslovsky², Philipp Krisai¹, Adrian Schweigler¹, Tobias Reichlin³, Nicolas Rodondi⁴, Andreas Müller⁵, Moa Haller⁶, Merit Röhl³, Annina Stauber⁷, Tim Sinnecker⁸, Leo H Bonati⁹, Thilo Burkard¹⁰, David Conen¹¹, Stefan Osswald¹, Michael Kühne¹, Christine S Zuern¹²

Affiliations

¹ Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
² Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
³ Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Inselspital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁵ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
⁶ Institute of Primary Health Care, University of Bern, Bern, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland.
⁷ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland; Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland.
⁸ Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Bern, Bern, Switzerland.
⁹ Department of Neurology and Stroke Center, University of Basel, Basel, Switzerland; Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
¹⁰ Cardiology Division, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland; Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland.
¹¹ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹² Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland; Cardiology Division, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: [email protected].

PMID: 39579917
DOI: 10.1016/j.amjcard.2024.11.008

Abstract

Cigarette smoking and atrial fibrillation (AF) are associated with impaired brain health. We investigated the association between smoking habits and brain lesions and volume in patients with AF. In patients with AF from a multicenter cohort study, we assessed smoking status (never, ex-, active), number of cigarettes smoked per day, smoking duration (years), pack-years, and time since smoking cessation. On brain magnetic resonance imaging, the prevalence and volumes of white matter lesions (WML) and small noncortical infarcts, and the volumes of gray matter and white matter were evaluated. Logistic and linear regression analyses were used to analyze the association between smoking habits and brain lesions and volumes. A total of 1,728 patients were enrolled (mean age 72.6 years, 27.5% female); 7.5% were active smokers; 48.5% were ex-smokers, and 44% had never smoked. We found linear associations of number of cigarettes smoked per day, pack-years, and older age at smoking cessation with reduced gray matter volume (p for linear trend <0.01, 0.02, and 0.01, respectively). Patients with a smoking duration in the second and third tertile had a greater risk for WML Fazekas ≥2 (odds ratio 1.86, 95% confidence interval 1.29 to 2.69, p <0.01 and 1.47 [1.02 to 2.12], p = 0.04), and exhibited larger WML volumes. Patients who had stopped smoking ≥16 years before enrollment were less likely to have small noncortical infarcts (odds ratio 0.46, 0.25 to 0.88, p = 0.02) and had smaller WML volumes (β: -0.451 mm³, -0.8 to -0.11, p = 0.01). In conclusion, smoking intensity and time since smoking cessation were associated with the presence and volume of brain lesions and with brain volumes in patients with AF.

Keywords: atrial fibrillation; brain deficits; smoking; smoking cessation.