Cardiovascular Impact of Tobacco Smoking on Heart Failure

Tobacco smoking remains a leading modifiable risk factor for the development and progression of heart failure. Chronic exposure to tobacco smoke contributes both indirectly, by accelerating atherosclerosis and hypertension, and directly, through myocardial injury mediated by metabolic disturbances, oxidative stress and inflammation. These processes promote adverse ventricular remodelling characterised by chamber dilatation, increased wall thickness and impaired contractile performance. In patients with established heart failure, continued smoking is associated with worsened symptoms, higher rates of rehospitalisation and increased mortality. Understanding these mechanisms underpins the imperative for integrated smoking-cessation strategies alongside conventional heart failure therapies worldwide.

Research from Nature Portfolio

Recent studies employing cardiac magnetic resonance imaging in large cohort populations have demonstrated that active smoking is dose-dependently linked to reductions in left and right ventricular ejection fraction and elevations in end-systolic volumes. Feature-tracking analyses reveal decrements in global longitudinal, radial and circumferential strain in daily smokers compared with non-smokers, indicative of subclinical systolic dysfunction. Parallel work in healthy individuals without overt cardiovascular disease has shown that smokers present with reduced right ventricular volumes, elevated markers of diffuse myocardial fibrosis and subtle declines in diastolic filling rates, emphasising the early impact of tobacco on myocardial structure and function.

Cardiovascular Impact of Tobacco Smoking on Heart Failure publication trend

The graph below shows the total number of articles in cardiovascular impact of tobacco smoking on heart failure across all publications each year (not limited to Nature Index journals).

Technical terms

Heart failure: A clinical syndrome in which the heart cannot pump sufficient blood to meet the body’s metabolic needs.

Ejection fraction: The percentage of blood ejected from a ventricle with each heartbeat, used as a measure of systolic function.

Ventricular remodelling: Structural and functional changes in the heart muscle and chambers in response to injury or chronic stress.

Lipotoxicity: Cellular dysfunction and injury caused by accumulation of lipid intermediates in non-adipose tissues.

Oxidative stress: Imbalance between the production of reactive oxygen species and antioxidant defences, leading to cellular damage.

References

1. Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: A systematic review and meta-analysis. Tobacco Induced Diseases (2020).
2. The Role of Lipotoxicity in Smoke Cardiomyopathy. PLOS ONE (2014).
3. Active Tobacco Smoking Impairs Cardiac Systolic Function. Scientific Reports (2020).
4. Association of smoking and physical inactivity with MRI derived changes in cardiac function and structure in cardiovascular healthy subjects. Scientific Reports (2019).
5. Short‐Term Cigarette Smoking in Rats Impairs Physical Capacity and Induces Cardiac Remodeling. BioMed Research International (2020).