Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality
Abstract Background —Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. In electrocardiogram (ECG) recordings abnormal durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization...
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Nature Portfolio
2024-12-01
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| Online Access: | https://doi.org/10.1038/s41598-024-82503-7 |
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| author | Affan Irfan Daniel W. Riggs George A. Koromia Hong Gao Andrew Paul DeFilippis Elsayed Z. Soliman Aruni Bhatnagar Alex P. Carll |
| author_facet | Affan Irfan Daniel W. Riggs George A. Koromia Hong Gao Andrew Paul DeFilippis Elsayed Z. Soliman Aruni Bhatnagar Alex P. Carll |
| author_sort | Affan Irfan |
| collection | DOAJ |
| description | Abstract Background —Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. In electrocardiogram (ECG) recordings abnormal durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Previous analyses of the National Health and Nutrition Examination Survey (NHANES) database for associations between smoking and ECG abnormalities were incomplete. To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) the association between serum cotinine and P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval. Methods and Results—We analyzed data from 5,653 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (> 15 ng/ml serum cotinine) and short (< 5th percentile) or long (> 95th percentile) ECG intervals, relative to reference (5–95th percentile). After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader effects of smoking on ECG were also assessed by survey-weighted linear regression of continuous cotinine and ECG, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS, whereas only short JT predicted mortality in nonsmokers. Conclusions —Smoking increases likelihood for rapid atrioventricular and ventricular depolarization and slow ventricular repolarization, which may promote cardiac arrhythmia and mortality. |
| format | Article |
| id | doaj-art-45e68d4319d142ed868ed3532905cd03 |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-45e68d4319d142ed868ed3532905cd032025-08-20T02:39:40ZengNature PortfolioScientific Reports2045-23222024-12-0114111110.1038/s41598-024-82503-7Smoking-associated electrocardiographic abnormalities predict cardiovascular mortalityAffan Irfan0Daniel W. Riggs1George A. Koromia2Hong Gao3Andrew Paul DeFilippis4Elsayed Z. Soliman5Aruni Bhatnagar6Alex P. Carll7Department of Cardiology, Mayo ClinicChristina Lee Brown Envirome Institute, University of LouisvilleDepartment of Cardiology Services, Department of Clinical & Translational Sciences, Marshall UniversityChristina Lee Brown Envirome Institute, University of LouisvilleChristina Lee Brown Envirome Institute, University of LouisvilleEpidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of MedicineChristina Lee Brown Envirome Institute, University of LouisvilleDepartment of Physiology, School of Medicine, University of LouisvilleAbstract Background —Smoking is associated with arrhythmia and sudden cardiac death, but the biological mechanisms remain unclear. In electrocardiogram (ECG) recordings abnormal durations of ventricular repolarization (QT interval), atrial depolarization (P wave), and atrioventricular depolarization (PR interval and segment), predict cardiac arrhythmia and mortality. Previous analyses of the National Health and Nutrition Examination Survey (NHANES) database for associations between smoking and ECG abnormalities were incomplete. To elucidate how smoking affects cardiac excitation, we assessed in a nationally representative sample (NHANES III) the association between serum cotinine and P duration, PR interval, PR segment, rate-corrected QT (QTc), QRS duration, and JT interval. Methods and Results—We analyzed data from 5,653 adults using survey-weighted multinomial logistic regression to estimate associations between tobacco use (> 15 ng/ml serum cotinine) and short (< 5th percentile) or long (> 95th percentile) ECG intervals, relative to reference (5–95th percentile). After adjustment for demographics, risk factors, and conduction-altering medications, smoking was associated with a higher odds of short PR interval, PR segment, and QRS, and long JT. Broader effects of smoking on ECG were also assessed by survey-weighted linear regression of continuous cotinine and ECG, which revealed cotinine inversely associated with PR segment and QTc. Over a 22-year follow-up, many ECG abnormalities predicted cardiovascular mortality in smokers, including long JT, QRS, and QTc, and short QRS, whereas only short JT predicted mortality in nonsmokers. Conclusions —Smoking increases likelihood for rapid atrioventricular and ventricular depolarization and slow ventricular repolarization, which may promote cardiac arrhythmia and mortality.https://doi.org/10.1038/s41598-024-82503-7CigaretteSmokingCotinineElectrocardiographyPR intervalPR segment |
| spellingShingle | Affan Irfan Daniel W. Riggs George A. Koromia Hong Gao Andrew Paul DeFilippis Elsayed Z. Soliman Aruni Bhatnagar Alex P. Carll Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality Scientific Reports Cigarette Smoking Cotinine Electrocardiography PR interval PR segment |
| title | Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality |
| title_full | Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality |
| title_fullStr | Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality |
| title_full_unstemmed | Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality |
| title_short | Smoking-associated electrocardiographic abnormalities predict cardiovascular mortality |
| title_sort | smoking associated electrocardiographic abnormalities predict cardiovascular mortality |
| topic | Cigarette Smoking Cotinine Electrocardiography PR interval PR segment |
| url | https://doi.org/10.1038/s41598-024-82503-7 |
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