Tobacco smoking from ages 10 to 24 years was associated with a 33% to 52% odds of premature structural and functional cardiac injury, according to a new study published in JACC. Furthermore, smoking from childhood through early adulthood was also associated with cardiac mass increase, with one-third of the effect estimate retained after controlling for risk factors.

Researchers at the University of Eastern Finland, collaborating with the University of Bristol, analyzed 1,931 children and young adults (62.7% female) using Avon Longitudinal Study of Parents and Children birth cohort data. Participants completed questionnaires about smoking activity in the past 30 days during clinic visits at ages 10, 13, 15, 17 and 24, and completed echocardiograms at 24 years, with 890 also completing echocardiograms at 17 years. Smoking prevalence was 0.3%, 1.6%, 13.6%, 24% and 26.4% at ages 10, 13, 15, 17 and 24, respectively, and 60% of those who initiated smoking in childhood continued smoking at age 24.

Prevalence of left ventricular (LV) hypertrophy increased from 2.8% at age 17 to 7.5% at age 24, and prevalence of LV diastolic (LVD) dysfunction increased from 10.4% to 16.9%.

Results showed that persistent smoking from ages 10 to 24 years was associated with higher odds of LV hypertrophy (odds ratio [OR], 1.52; 95% CI, 1.39-1.66; p<0.001), LVD dysfunction (OR, 1.33; 95% CI, 1.22-1.46; p<0.001), high relative wall thickness (OR, 1.38; 95% CI, 1.26-1.51; p<0.001) and high LV filling pressure (OR, 1.35; 95% CI, 1.25-1.45; p<0.001) at 24 years. It was also associated with higher LV mass index at ages 17 to 24 after full covariate adjustment.

“This study shows that teen smoking doesn’t just increase the risk of heart disease later in life – it causes early and lasting damage to heart muscle and function,” said Emily Bucholz, MD, MPH, PhD, associate editor of JACC, who called it “a wake-up call for prevention efforts to protect young hearts early.”

“The increase of cardiac mass structure in just a few years of smoking should convey how dangerous the consequences are for people who continue to smoke from a young age,” said Andrew O. Agbaje, MD, lead and senior author of the study. “Parents and caregivers must lead by example and government agencies should be bold to address the preventable heart disease risk by creating a smoke and nicotine-free country. Raising tobacco taxes is insufficient because the cost of health care due to smoking-related diseases twice exceeds tobacco tax profits. Why should we pay for what is killing our teenagers softly?”

Clinical Topics: Prevention, Smoking

Keywords: Hypertrophy, Left Ventricular, Smoking