Active smoking and cumulative cigarette exposure were associated with subtle alterations in left ventricular structure and function in a group of elderly individuals free of overt coronary artery disease and heart failure, researchers found.

"We've known for years that smoking could lead to heart attacks, which may result in reductions in the pumping ability of the heart," senior author Dr. Scott Solomon of Brigham and Women's Hospital and Harvard Medical School in Boston said by email.

"Our data suggest that smoking can independently lead to thickening of the heart and worsening of heart function, which may lead to a higher risk for heart failure, even in people who don't have heart attacks," Solomon added.

The researchers assessed the relationship between smoking and echocardiographic measures in more than 4,500 adults who were about 76 years old on average.

Almost 300 of them, or about 6 percent of the total, were current smokers. Roughly half were former smokers and about 43 percent had no history of smoking.

Current smokers were slightly younger, on average, less likely to be overweight and had better kidney function than the other groups.

People who had never smoked were more likely to be female, less likely to drink alcohol and tended to have healthier cholesterol levels.

Former smokers had used tobacco products for around 18 years on average, while current smokers typically developed the habit around 46 years earlier, researchers report in the journal Circulation: Cardiovascular Imaging.

Compared with never smokers, current smokers had greater left ventricular (LV) mass index, LV mass/volume ratio, higher prevalence of LV hypertrophy, and worse diastolic function, after adjusting for potential confounding factors.

Former smokers showed similar echocardiographic features when compared with never smokers. Furthermore, estimated pack-years and years of smoking, measures of cumulative cigarette exposure, were associated with greater LV mass index, LV mass/volume ratio, and worse diastolic function.

One limitation of the study, however, is that it relied on participants to accurately recall and report any history of tobacco use, the authors note.

Because smoking can kill people and cause a variety of heart problems, it's also possible that the population of current smokers in the study were healthier than typical cigarette users the authors also point out.

Previous studies examining whether smoking directly impacts the heart muscle leading to thickening, stiffness and impaired filling have yielded mixed results, said Dr. Gregg Fonarow, co-chief of the division of cardiology at the University of California, Los Angeles.

"This study provides evidence in both men and women that smoking directly damages the heart muscle leading to thickening, increased stiffness, and impaired filling, which in turn leads to heart failure, which is a common, costly, and deadly condition," Fonarow, who wasn't involved in the study, said by email.

Solomon noted that more research is still needed to assess whether other products such as chewing tobacco or electronic cigarettes would have the same impact on the structure and function of the heart as traditional cigarettes.

"The good news is that former smokers had similar heart structure and function as compared to never smokers, suggesting that the potential effects of tobacco on the myocardium might be reversible after smoking cessation," Solomon added.

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