The association of smoking with cardiomyopathy.

We investigated the possibility that smoking has an association with ventricular wall-motion abnormalities that is independent of its known association with coronary occlusion. We studied 4763 men between the ages of 35 and 74 who had diagnostic coronary angiography and ventriculography. We considered three kinds of wall-motion abnormalities: hypokinesis in one to four ventricular segments, hypokinesis in five to six ventricular segments (diffuse hypokinesis), and akinetic or dyskinetic wall motion in at least one segment. Among men younger than 55, the relative risk of diffuse hypokinesis was 2.78 (1.1 to 6.99) for heavy smokers as compared with nonsmokers. Adjusting for the degree of coronary occlusion or eliminating subjects with a history of myocardial infarction did not change this relative risk. Among men who were 55 or older the relative risk (odds ratio for heavy smokers as compared with nonsmokers) was not significant (0.55 to 2.28). Regardless of age the relative risk of akinesis or dyskinesis, adjusted for coronary stenosis, was significant: 1.84 (1.28 to 2.65) for men under 55 and 1.57 (1.12 to 2.19) for men 55 or older. These results suggest that smoking is related to both cardiomyopathy and transmural myocardial infarction and that the relationships are largely separate from the association of smoking with coronary stenosis.