Smoking is associated with increased risk of cardiovascular events, disease severity, and mortality among patients hospitalized for SARS-CoV-2 infections

Abstract

The clinical sequalae of SARS-CoV-2 infection are in part dependent upon age and pre-existing health conditions. Although the use of tobacco products decreases cardiorespiratory fitness while increasing susceptibility to microbial infections, limited information is available on how smoking affects COVID-19 severity. Therefore, we examined whether smokers hospitalized for COVID-19 are at a greater risk for developing severe complications than non-smokers. Data were from all hospitalized adults with SARS-CoV-2 infection from the American Heart Association's Get-With-The-Guidelines COVID-19 Registry, from January 2020 to March 2021, which is a hospital-based voluntary national registry initiated in 2019 with 122 participating hospitals across the United States. Patients who reported smoking at the time of admission were classified as smokers. Severe outcome was defined as either death or the use of mechanical ventilation. Of the 31,545 patients in the cohort, 6,717 patients were 1:2 propensity matched (for age, sex, race, medical history, medications, and time-frame of hospital admission) and classified as current smokers or non-smokers according to admission data. In multivariable analyses, after adjusting for sociodemographic characteristics, medical history, medication use, and the time of hospital admission, patients self-identified as current smokers had higher adjusted odds of death (adjusted odds ratio [aOR], 1.41; 95% CI, 1.21-1.64), the use of mechanical ventilation (aOR 1.15; 95% CI 1.01-1.32), and increased risk of major adverse cardiovascular events (aOR, 1.27; 95% CI 1.05-1.52). Independent of sociodemographic characteristics and medical history, smoking was associated with a higher risk of severe COVID-19, including death.

Fig 1. Multivariate analysis of associations between smoking and death in subpopulations among the propensity-matched study population of the AHA COVID-19 CVD Registry from December 2020 to March 2021.

Death is defined as patient’s disposition status “Expired” at the time of discharge. Obesity is defined as BMI > = 30 kg/m². OR, Odds ratio; CI, Confidence interval.

Fig 2. Multivariate analysis of associations between smoking and mechanical ventilator use in subpopulations among the propensity-matched study population of the AHA COVID-19 CVD Registry from December 2020 to March 2021.

Mechanical ventilation use is defined as the hospitalization, intubated, or placed on mechanical ventilation. Obesity is defined as BMI > = 30 kg/m². OR, Odds ratio; CI, Confidence interval.

Fig 3. Multivariate analysis of associations between smoking and major adverse cardiac events (MACE) in subpopulations among the propensity-matched study population of the AHA COVID-19 CVD Registry from December 2020 to March 2021.

Major adverse cardiac events (MACE) is defined as the hospitalization, intubated, or placed on mechanical ventilation. Obesity is defined as BMI > = 30 kg/m². OR, Odds ratio; CI, Confidence interval.