Author + information
- Received July 1, 2019
- Accepted July 23, 2019
- Published online September 23, 2019.
- Christopher A. Groh, MDa,
- Eric Vittinghoff, PhDb,
- Emelia J. Benjamin, MD, ScMc,
- Josée Dupuis, PhDd and
- Gregory M. Marcus, MD, MASa,∗ (, )@gregorymmarcus
- aElectrophysiology Section, Division of Cardiology, University of California, San Francisco, California
- bDepartment of Epidemiology and Biostatistics, University of California, San Francisco, California
- cDepartment of Medicine, Boston University School of Medicine and Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- dDepartment of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Gregory M. Marcus, Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, M1180B, San Francisco, California 94143-0124.
Background Cigarette smoking is known to increase the risk of atrial fibrillation (AF), and a recent cross-sectional analysis suggested that parental smoking may be an AF risk factor.
Objectives The purpose of this study was to assess if parental smoking predicts offspring AF in the Framingham Heart Study.
Methods This study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring’s childhood. Framingham participants were evaluated every 2 to 8 years and were under routine surveillance for incident AF. The authors assessed AF incidence among Offspring participants exposed to parental smoking through age 18 years and performed a mediation analysis to determine the extent to which offspring smoking might explain observed associations.
Results Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.00 to 1.39; p = 0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio [OR]: 1.34; 95% CI: 1.17 to 1.54; p < 0.001). Offspring smoking mediated 17% (95% CI: 1.5% to 103.3%) of the relationship between parental smoking and offspring AF.
Conclusions Childhood secondhand smoke exposure predicted increased risk for adulthood AF after adjustment for AF risk factors. Some of this relationship may be mediated by a greater propensity among offspring of smoking parents to smoke themselves. These findings highlight potential new pathways for AF risk that begin during childhood, offering new evidence to motivate smoking avoidance and cessation.
This research was supported by funds from the Tobacco Related-Disease Research Program Office of the University of California (Award #27IR-0027 to Dr. Marcus), the American Heart Association Clinical Scientist Training Program (Award #17CPOST33660315 to Dr. Groh, Dr. Marcus sponsor), the National Institutes of Health National Research Service Award Postdoctoral Fellowship (Award #1F32HL140809-01 to Dr. Groh, Dr. Marcus sponsor), and contract #HHSN268201500001I from the National Heart, Lung, and Blood Institute to the Framingham Heart Study. Dr. Benjamin is supported by the Robert Wood Johnson Foundation; R01HL128914, 2R01 HL092577, R01HL141434, and 2U54HL120163 from the National Heart, Lung, and Blood Association; and 18SFRN34110082 from the American Heart Association. Dr. Marcus has received research funding from Jawbone Health, Eight, and Medtronic; and has served as a consultant for and holds equity in InCarda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 1, 2019.
- Accepted July 23, 2019.
- 2019 American College of Cardiology Foundation
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