• Robert Preidt
• Posted November 17, 2021

Too Often, Fatal Heart Attack or Stroke Is First Sign of Heart Trouble in Smokers

A fatal heart attack or stroke is often the first indication of heart disease in middle-aged smokers, according to a new study.

It also found that heart disease is the leading complication among smokers when compared with deaths from other causes -- including lung cancer. In addition, smoking is associated with developing heart disease at a younger age and shortening a person's life by as much as four to five years.

"These results offer a very compelling message that people who smoke need to hear -- smoking can kill you before you even know you have cardiovascular disease," said Dr. Esa Davis, a member of the American Heart Association's Council on Lifestyle and Cardiometabolic Health.

"It can, indeed, be a silent killer," noted Davis, who was not involved in the study.

For the study, researchers examined data from nine long-term studies that included more than 106,000 U.S. adults, ages 20-79. They were free of heart disease at the start of the studies, which had follow-up times ranging from 10 to 25 years.

The analysis showed that middle-aged women who smoked were nearly two times more likely to have a fatal event as their first sign of heart disease than women in that age group who didn't smoke.

Middle-aged men who smoked had a 79% chance of having a fatal event as their first sign of heart disease. That risk was about 1.5 times more likely than for nonsmokers.

Among middle-aged women who smoked, long-term risk of heart disease was nearly 35%, compared with about 25% for nonsmokers. Among middle-aged men, rates were 46% for smokers and almost 36% for nonsmokers.

Smoking was associated with the development of heart disease five years earlier in middle-aged men and nearly four years earlier in middle-aged women. Similar results were seen in younger and older adults.

Among 20- to 39-year-olds, heart disease risk started to increase significantly after about 10 years of follow-up in men, and about 20 years of follow-up in women.

Young men who smoked had the highest long-term risk for heart attacks (24%), while young women had the highest long-term risk (11.3%) for other heart disease-related causes of death, such as stroke or heart failure.

Among all age groups, a majority of first cardiovascular disease (CVD) events were fatal or nonfatal heart attack. Strokes were the No. 2 cause of first heart disease event among younger adults, while heart failure was No. 2 among middle-aged and older adults.

The study was published Nov. 17 in the Journal of the American Heart Association.

"Preventing a heart attack, stroke or heart failure is vital, yet preventing unexpected sudden death as the first manifestation of cardiovascular disease is clearly a priority," said lead author Dr. Sadiya Khan, an assistant professor in the cardiology division at Northwestern University's Feinberg School of Medicine in Chicago.

"People who smoke may not realize the harm cigarettes are causing their body until it's too late," Khan said in a journal news release.

She pointed to another notable finding among smokers -- the early onset of cardiovascular disease.

"There's not a lot of research on young adults who smoke, particularly among young men. Our study adds important perspective," Khan said.

Davis, of the tobacco treatment service at the University of Pittsburgh Medical Center, noted that heart attacks, strokes and other types of disease affecting the heart and blood vessels don't always have early symptoms.

"If you don't know you have CVD, it can't be treated," she said. "You can help prevent CVD by never smoking or stopping smoking as soon as possible."

More information

The U.S. National Heart, Lung, and Blood Institute has more on smoking and your heart.

SOURCE: Journal of the American Heart Association, news release, Nov. 17, 2021