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:S0002-9149(24)00796-3. 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 of Basel, University Hospital Basel, Basel, Switzerland.
³ Department of Cardiology, Inselspital, 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, Bern University Hospital, University of Bern, Bern Switzerland.
⁵ Department of Cardiology, Triemli Hospital Zürich, Zürich, Switzerland.
⁶ 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 Basel, Basel, Switzerland.
⁹ Department of Neurology and Stroke Center, University Hospital Basel, 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, ON, 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: christine.meyerzuern@usb.ch.

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

Abstract

Introduction: Cigarette smoking and atrial fibrillation (AF) are associated with an impaired brain health. We investigated the association between smoking habits, brain lesions and brain volume in patients with AF.

Methods: In AF patients from a multicentre cohort study, we assessed smoking status (never, ex, active), number of cigarettes smoked per day (cpd), smoking duration (years), pack-years (pky) and time since smoking cessation. On brain MRI, the prevalence and volumes of white matter lesions (WML) and small non-cortical infarcts (SNCI) and the volumes of grey matter (GM) and white matter (WM) were evaluated. Logistic and linear regression analyses were used to analyse the association between smoking habits, brain lesions and volumes.

Results: 1728 patients were enrolled (mean age 72.6 years, 27.5% females). 7.5% were active smokers, 48.5% ex- and 44% never smokers. We found linear associations of cpd, pky and older age at smoking cessation with reduced GM 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 higher risk for WML Fazekas ≥2 (OR (95% CI) 1.86 (1.29; 2.69), p<0.01) and 1.47 (1.02; 2.12), p=0.04) and exhibited larger WML volumes. Patients who had stopped smoking ≥16 years before enrolment were less likely to have SNCI (OR 0.46 (0.25; 0.88), p= 0.02) and had smaller WML volumes (β: -0.451 mm³(-0.8; -0.11), p=0.01).

Conclusion: In conclusion, smoking intensity and time since smoking cessation were associated with the presence and volume of brain lesions and brain volumes in patients with AF.

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