Wen Jiahua, Yan Zhaohan, Cao Yue, Ma Huisong, Zeng Yunying, Zhao Ling, Su Jianzhao, Hu Yunzhao, Huang Yuli
Department of Cardiology, The Eighth Affiliated Hospital, Southern Medical University (The First People's Hospital of Shunde) Foshan, No. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong Province 528308, China.
Medical Research Center, The Eighth Affiliated Hospital, Southern Medical University (The First People's Hospital of Shunde), No. 1 Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong 528308, China.
ESC Heart Fail. 2026 Feb 3;13(1). doi: 10.1093/eschf/xvag049.
We aimed to investigate the association between time to first cigarette after waking (TTFC) and incident heart failure (HF) in a large prospective cohort.
This study included 229 391 participants from the UK Biobank. Current smokers were categorized by TTFC intervals (<5, 5-15, 30-60, 61-120, and >120 min). Multivariable Cox proportional hazards models were employed to assess the relationship between TTFC and HF. Joint analyses evaluated the combined associations of TTFC with daily cigarette amount and smoking duration. Subgroup and interaction analyses were conducted by age, sex, BMI, education, and alcohol consumption.
During a median follow-up of 15.5 years, 6912 (3.01%) incident HF cases occurred among 229 391 participants. The cohort included 203 653 (88.77%) non-smokers (age 55.9 ± 8.1 years, 41.4% female, 91.5% White ethnicity, 2.7% incident HF cases) and 25 738 (11.23%) current smokers (age 54.5 ± 8.1 years, 49.0% female, 89.1% White ethnicity, 5.7% incident HF cases). A significant dose-dependent relationship was observed between shorter TTFC and HF risk (P for trend <.001). Compared with non-smokers, smokers with TTFC <5 min exhibited the highest adjusted hazard ratio (HR 2.22, 95% CI 1.58-3.10; P < .001), corresponding to an absolute risk difference of 4.03%. Joint analyses showed that among individuals smoking ≤median cigarettes/day, HF risk increased from HR 1.61 (95% CI: 1.35-1.92; P < .001) to 2.25 (1.86-2.72; P < .001) across decreasing TTFC categories; among those smoking >median cigarettes/day, the corresponding HRs ranged from 1.95 (1.41-2.69; P < .001) to 2.17 (1.74-2.69; P < .001). Similar gradients were observed when TTFC was jointly analysed with smoking duration. Subgroup analyses indicated stronger associations in participants aged <60 years (HR 1.98, 95% CI 1.56-2.51; P < .001 for TTFC <15 min) than in those ≥60 years (HR 1.55, 95% CI 1.25-1.91; P < .001), both compared with non-smokers (P for interaction <.001).
Shorter TTFC is independently and dose-dependently associated with a higher risk of incident HF, even after accounting for smoking burden and comorbidities. TTFC assessment may improve HF risk stratification, particularly in younger individuals.
我们旨在研究在一个大型前瞻性队列中，醒来后至吸第一支烟的时间（TTFC）与心力衰竭（HF）发病之间的关联。
本研究纳入了来自英国生物银行的229391名参与者。当前吸烟者根据TTFC间隔进行分类（<5分钟、5 - 15分钟、30 - 60分钟、61 - 120分钟和>120分钟）。采用多变量Cox比例风险模型评估TTFC与HF之间的关系。联合分析评估了TTFC与每日吸烟量和吸烟持续时间的综合关联。按年龄、性别、体重指数、教育程度和饮酒情况进行亚组分析和交互作用分析。
在15.5年的中位随访期间，229391名参与者中发生了6912例（3.01%）HF发病病例。该队列包括203653名（88.77%）非吸烟者（年龄55.9±8.1岁，41.4%为女性，91.5%为白人，2.7%为HF发病病例）和25738名（11.23%）当前吸烟者（年龄54.5±8.1岁，49.0%为女性，89.1%为白人，5.7%为HF发病病例）。观察到TTFC越短与HF风险之间存在显著的剂量依赖关系（趋势P<.001）。与非吸烟者相比，TTFC<5分钟的吸烟者调整后的风险比（HR）最高（HR 2.22，95%CI 1.58 - 3.10；P<.001），绝对风险差异为4.03%。联合分析表明，在每天吸烟≤中位数的个体中，随着TTFC类别降低，HF风险从HR 1.61（95%CI：1.35 - 1.92；P<.001）增加到2.25（1.86 - 2.72；P<.001）；在每天吸烟>中位数的个体中，相应的HR范围为1.95（1.41 - 2.69；P<.001）至2.17（1.74 - 2.69；P<.001）。当TTFC与吸烟持续时间进行联合分析时，观察到类似的梯度。亚组分析表明，与非吸烟者相比，年龄<60岁的参与者（TTFC<15分钟时，HR 1.98，95%CI 1.56 - 2.51；P<.001）的关联比≥60岁的参与者（HR 1.55，95%CI 1.25 - 1.91；P<.001）更强（交互作用P<.001）。
即使在考虑吸烟负担和合并症后，较短的TTFC仍与HF发病风险较高独立且呈剂量依赖相关。TTFC评估可能改善HF风险分层，特别是在年轻个体中。
