Smoking and incidence of atrial fibrillation: Results from the Atherosclerosis Risk in Communities (ARIC) study

Alanna M. Chamberlain, Sunil K. Agarwal, Aaron R. Folsom, Sue Duval, Elsayed Z. Soliman, Marietta Ambrose, Lynn E. Eberly, Alvaro Alonso

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192 Scopus citations


Background: Cigarette smoking increases the risk of coronary heart disease, but whether smoking increases atrial fibrillation (AF) is uncertain. Objective: The purpose of this study was to determine the association of cigarette smoking with incident AF in a population-based cohort of blacks and whites. Methods: We determined the risk of incident AF through December 2002 in relation to baseline (19871989) smoking status and cigarette-years of smoking in over 15,000 participants of the prospective Atherosclerosis Risk in Communities (ARIC) study. Results: Over a mean follow-up of 13.1 years, 876 incident AF events were identified. Compared to never smokers, the multivariable-adjusted hazard ratios (HRs) for AF were 1.32 (95% confidence interval [CI] 1.101.57) in former smokers, 2.05 (95% CI 1.712.47) in current smokers, and 1.58 (95% CI 1.351.85) in ever smokers. In the highest tertile of accumulated smoking amount (>675 cigarette-years), the incidence of AF was 2.10 times greater (95% CI 1.742.53) than in those who never smoked. Associations were similar by gender, race, type of event (AF and atrial flutter), and when only AF events identified by study exam ECGs were included. Finally, individuals who quit smoking exhibited a trend indicating a slightly lower risk of developing AF (HR 0.88, 95% CI 0.651.17) compared to those who continued to smoke. Conclusion: Smoking was associated with the incidence of AF, with more than a two-fold increased risk of AF attributed to current smoking. In addition, a trend toward a lower incidence of AF appeared among smokers who quit compared to continued smokers.

Original languageEnglish (US)
Pages (from-to)1160-1166
Number of pages7
JournalHeart Rhythm
Issue number8
StatePublished - Aug 2011

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) Contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. Dr. Chamberlain was supported by NHLBI Grant T32-HL-007779 . This study was further supported by American Heart Association Grant 09SDG2280087 and NHLBI Grant RC1HL099452 .


  • Arrhythmia
  • Atrial fibrillation
  • Cigarette
  • Smoking


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