UMMS Affiliation

Department of Population and Quantitative Health Sciences

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Document Type



Cardiology | Cardiovascular Diseases | Epidemiology


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 (beta=-0.082, SE=0.031, p=0.008), RVS' (beta=-0.343, SE=0.156, p=0.028) and RVE' (beta=-0.715, SE=0.195, p < 0.001) compared with never smokers. Former smokers had a significantly lower RVE' compared with never smokers (beta=-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.


cardiac function, echocardiography, smoking

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Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. Open access: This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: licenses/by/4.0/.

DOI of Published Version



Moreira HT, Armstrong AC, Nwabuo CC, Vasconcellos HD, Schmidt A, Sharma RK, Ambale-Venkatesh B, Ostovaneh MR, Kiefe CI, Lewis CE, Schreiner PJ, Sidney S, Ogunyankin KO, Gidding SS, Lima JAC. Association of smoking and right ventricular function in middle age: CARDIA study. Open Heart. 2020 Mar 8;7(1):e001270. doi: 10.1136/openhrt-2020-001270. PMID: 32201592; PMCID: PMC7061887. Link to article on publisher's site

Journal/Book/Conference Title

Open heart

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.