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Original research
Association of smoking and right ventricular function in middle age: CARDIA study
  1. Henrique T Moreira1,2,
  2. Anderson C Armstrong1,
  3. Chike C Nwabuo1,
  4. Henrique D Vasconcellos1,
  5. Andre Schmidt2,
  6. Ravi K Sharma1,
  7. Bharath Ambale-Venkatesh1,
  8. Mohammad R Ostovaneh1,
  9. Catarina I Kiefe3,
  10. Cora E Lewis4,
  11. Pamela J Schreiner5,
  12. Stephen Sidney6,
  13. Kofo O Ogunyankin7,
  14. Samuel S Gidding8 and
  15. Joao A C Lima1
  1. 1Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Division of Cardiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
  3. 3Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  4. 4Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  5. 5Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
  6. 6Division of Research, Kaiser Permanente Division of Research, Oakland, California, USA
  7. 7Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  8. 8Chief Medical Officer, The FH Foundation, Passadena, California, USA
  1. Correspondence to Dr Joao A C Lima; jlima{at}


Objective To evaluate the association of cigarette smoking and right ventricular (RV) systolic and diastolic functions in a population-based cohort of individuals at middle age.

Methods This cross-sectional study included participants who answered the smoking questionnaire and underwent echocardiography at the Coronary Artery Risk Development in Young Adulthood year 25 examination. RV systolic function was assessed by echocardiographic-derived tricuspid annular plane systolic excursion (TAPSE) and by right ventricular peak systolic velocity (RVS’), while RV diastolic function was evaluated by early right ventricular tissue velocity (RVE’). Multivariable linear regression models assessed the relationship of smoking with RV function, adjusting for age, sex, race, body mass index, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, diabetes mellitus, alcohol consumption, pulmonary function, left ventricular systolic and diastolic function and coronary artery calcium score.

Results A total of 3424 participants were included. The mean age was 50±4 years; 57% were female; and 53% were black. There were 2106 (61%) never smokers, 750 (22%) former smokers and 589 (17%) current smokers. In the multivariable analysis, current smokers had significantly lower TAPSE (β=−0.082, SE=0.031, p=0.008), RVS’ (β=−0.343, SE=0.156, p=0.028) and RVE’ (β=−0.715, SE=0.195, p<0.001) compared with never smokers. Former smokers had a significantly lower RVE’ compared with never smokers (β=−0.414, SE=0.162, p=0.011), whereas no significant difference in RV systolic function was found between former smokers and never smokers.

Conclusions In a large multicenter community-based biracial cohort of middle-aged individuals, smoking was independently related to both worse RV systolic and diastolic functions.

  • echocardiography
  • smoking
  • cardiac function

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  • Correction notice In the end matter, ‘Provenance and peer review’ statement has been correctly updated as ‘Not commissioned; externally peer reviewed’.

  • Contributors All authors have contributed significantly to the submitted work. HM and JACL contributed to the conception and design, analysis and interpretation of the data, drafting of the manuscript and critical review; ACA contributed to conception and design, interpretation of the data and critical review; CCN, HV, AS, RKS, BA-V and MRO contributed to interpretation of the data and critical review; CIK, CL, PS, SS, KOO and SG contributed to critical review. All authors read and approved the final version of the manuscript submitted.

  • Funding The Coronary Artery Risk Development in Young Adults Study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I and HHSN268201800007I from the National Heart, Lung, and Blood Institute.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review boards at each site approved study protocols, and all participants gave written informed consent to the study protocols. The work was conducted in accordance with the Declaration of Helsinki.

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

  • Data availability statement Data are available upon reasonable request. The Coronary Artery Risk Development in Young Adulthood Study has provided National Heart, Lung, and Blood Institute (NHLBI) Data Repository datasets for exams conducted during years 0-25, as well as for follow-up contacts for which data collection has been completed for at least 5 years, and for adjudicated morbid and mortal events. The NHLBI distributes these data; additional information, including the procedures on how to request these data, can be found on the NHLBI website (

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