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Original research article
Smoking intensity and duration is associated with cardiac structure and function: the ECHOcardiographic Study of Hispanics/Latinos
  1. J Adam Leigh1,
  2. Robert C Kaplan2,
  3. Katrina Swett1,
  4. Pelbreton Balfour3,
  5. Mayank M Kansal4,
  6. Gregory A Talavera5,
  7. Krista Perreira6,
  8. Michael J Blaha7,
  9. Emelia J Benjamin8,
  10. Rosemarie Robertson9,
  11. Aruni Bhartnagar10 and
  12. Carlos J Rodriguez1
  1. 1Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Einstein College of Medicine, Bronx, North Carolina, USA
  3. 3University of Virginia Health System, Charlottesville, Virginia, USA
  4. 4University of Illinois at Chicago, Chicago, Illinois, USA
  5. 5San Diego State University, San Diego, California, USA
  6. 6University of North Carolina, Chapel Hill, North Carolina, USA
  7. 7Johns Hopkins Health System, Baltimore, Maryland, USA
  8. 8Boston University School of Medicine, Boston, Massachusetts, USA
  9. 9American Heart Association, Louisville, Kentucky, USA
  10. 10University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Carlos J Rodriguez; crodrigu{at}


Objective Cardiovascular disease is the leading cause of death in smokers and this relationship is complicated by the multiplicity of cardiovascular effects of smoking. However, the relationship between intensity and duration of cigarette smoking and echocardiographic measures of right and left ventricular structure and function has been poorly studied.

Methods We examined ECHO-SOL (Echocardiographic Study of Hispanics/Latinos) participants, a subset of the Hispanic Community Health Study/Study of Latinos. Participants were administered a detailed tobacco exposure questionnaire and a comprehensive echocardiography exam. Multivariable linear regression models (adjusted for age, sex, obesity, hypertension and diabetes statuses) were performed using sampling weights. Statistical significance was defined at p<0.01.

Results There were 1818 ECHO-SOL participants (57.4% women, mean age 56.4 years). Among current smokers (n=304), increased duration of smoking, as measured by a younger age of smoking initiation, was significantly associated with higher mean left ventricular mass (LVM) and lower right ventricular (RV) function (lower right ventricular stroke volumes). More cigarettes smoked per day was significantly associated with higher mean LVM, worse diastolic function (higher E/e′ ratio), worse LV geometry (increased relative wall thickness) and worse RV function (decreasing right ventricular stroke volume). Among current smokers, higher mean lifetime pack-years (a combined measure of smoking intensity and duration) was associated with higher LVM, worse LV geometry, worse diastolic function, greater RV dilatation and worse RV function.

Conclusions There is a dose–response relationship between intensity and duration of cigarette tobacco smoking with unfavourable changes of multiple measures of right-sided and left-sided cardiac structure and function.

  • smoking
  • right ventricular function
  • left ventricular function
  • echocardiography
  • epidemiology

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  • Contributors All authors have read and approved the paper, have met the criteria for authorship as established by the International Committee of Medical Journals Editors, believe that the paper represents honest work, and are able to verify the validity of the results reported.

  • Funding The HCHS/SOL was carried out as a collaborative study supported by contracts from the National Heart, Lung, and Blood Institute (NHLBI) to the University of North Carolina (N01- HC65233), University of Miami (N01-HC65234), Albert Einstein College of Medicine (N01-HC65235), Northwestern University (N01-HC65236) and San Diego State University (N01-HC65237). The following institutes/centres/offices contribute to the HCHS/SOL through a transfer of funds to the NHLBI: National Institute on Minority Health and Health Disparities, National Institute on Deafness and Other Communication Disorders, National Institute of Dental and Craniofacial Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, NIH Institution-Office of Dietary Supplements. ECHO-SOL was supported by a grant from the NHLBI (R01 HL104199, Epidemiologic Determinants of Cardiac Structure and Function among Hispanics: Carlos J. Rodriguez, MD, MPH, Principal Investigator). An NHLBI T32HL076132 (to Adam Leigh, MD) also provided partial support for this manuscript. Research reported in this publication was also supported by the AHA Tobacco Regulation and Addiction Center (A-TRAC); grant number HL120163 from the NHLBI and the FDA Center for Tobacco Products. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Ethics approval Institutional Review Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement All HCHS-SOL data will be included in a limited access database that will be available to the larger scientific public as part of the main HCHS-SOL study database for public use. It will be encouraged that all use of data and publications from ancillary studies invite the participation of the ancillary study PI and co-investigators.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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