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. 2023 Mar;42(3):377-389.
doi: 10.1016/j.healun.2022.10.007. Epub 2022 Oct 17.

Smoking history and pulmonary arterial hypertension: Demographics, onset, and outcomes

Adaani E Frost  1 , Carol Zhao  2 , Harrison W Farber  3 , Raymond Benza  4 , Joseph Yen  5 , Mona Selej  2 , C Gregory Elliott  6
Affiliations

Smoking history and pulmonary arterial hypertension: Demographics, onset, and outcomes

Adaani E Frost et al. J Heart Lung Transplant. 2023 Mar.

Abstract

Background: Smoking prevalence and its association with pulmonary arterial hypertension (PAH) outcomes have not been described in patients in the United States.

Methods: Using the US-based Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), the prevalence, demographics, and outcomes in ever- versus never-smokers with PAH were determined.

Results: Ever-smoking status was more prevalent in males (61.7%) than in females (42.9%) enrolled in REVEAL. Ever-smokers were older than never-smokers at the time of PAH diagnosis and REVEAL enrollment. The time to first hospitalization, transplant-free survival, and survival did not differ between ever- and never-smokers overall; however, in newly diagnosed males, ever-smoking was associated with earlier death (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.1-3.0; p = 0.0199), the composite of transplant or death (HR 2.2, 95% CI 1.4-3.6; p = 0.0008), and first hospitalization (HR 1.8, 95% CI 1.2-2.7; p = 0.0063), though smoking exposure (pack-years) did not differ between newly and previously diagnosed males.

Conclusions: REVEAL PAH data demonstrate that smoking prevalence in male PAH patients is disproportionate. The prevalence of cigarette smoking was significantly higher in males than females enrolled in REVEAL. Ever-smoking status was associated with increased age at PAH diagnosis and, in newly diagnosed male PAH patients, earlier time to hospitalization and shorter survival after PAH diagnosis.

Keywords: REVEAL registry; demographics; outcomes; prevalence; pulmonary arterial hypertension; smoking.

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Conflict of interest statement

Disclosure statement AEF reports honoraria from Johnson & Johnson (parent company of Actelion) for participation in blinded study data safety monitoring committee for an Actelion-sponsored study and honoraria from Acceleron and United Therapeutics for participation in EAC and DSMB and from PhaseBio for participation in a steering committee for a PAH study. CZ, JY, and MS were/are employees and stockholders of Actelion Pharmaceuticals US, Inc., in South San Francisco, California. HWF is a speaker for Bayer and a scientific advisory board member for Janssen Pharmaceutical Companies of Johnson & Johnson, Acceleron Pharma, Altavant, and United Therapeutics, and has received research support from Janssen Pharmaceutical Companies of Johnson & Johnson, Eiger, Reata Pharmaceuticals, and United Therapeutics. RLB's institution has received grants from The American Heart Association, Bayer, The National Heart, Lung, and Blood Institute of the National Institutes of Health (NHLBI/NIH), and United Therapeutics. CGE reports grants from Arena Pharmaceuticals, Respira Therapeutics, and Lung Biotechnology PBC, and has acted as study PI for United Therapeutics and committee chair for Lung Rx LLC, outside the submitted work.

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