Childhood Tobacco Smoke Exposure and Risk of Atrial Fibrillation in Adulthood

J Am Coll Cardiol. 2019 Oct 1;74(13):1658-1664. doi: 10.1016/j.jacc.2019.07.060.


Background: Cigarette smoking is known to increase the risk of atrial fibrillation (AF), and a recent cross-sectional analysis suggested that parental smoking may be an AF risk factor.

Objectives: The purpose of this study was to assess if parental smoking predicts offspring AF in the Framingham Heart Study.

Methods: This study analyzed Framingham Offspring cohort participants with parents in the Original cohort with known smoking status during the offspring's childhood. Framingham participants were evaluated every 2 to 8 years and were under routine surveillance for incident AF. The authors assessed AF incidence among Offspring participants exposed to parental smoking through age 18 years and performed a mediation analysis to determine the extent to which offspring smoking might explain observed associations.

Results: Of 2,816 Offspring cohort participants with at least 1 parent in the Original cohort, 82% were exposed to parental smoking. For every pack/day increase in parental smoking, there was an 18% increase in offspring AF incidence (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.00 to 1.39; p = 0.04). Additionally, parental smoking was a risk factor for offspring smoking (adjusted odds ratio [OR]: 1.34; 95% CI: 1.17 to 1.54; p < 0.001). Offspring smoking mediated 17% (95% CI: 1.5% to 103.3%) of the relationship between parental smoking and offspring AF.

Conclusions: Childhood secondhand smoke exposure predicted increased risk for adulthood AF after adjustment for AF risk factors. Some of this relationship may be mediated by a greater propensity among offspring of smoking parents to smoke themselves. These findings highlight potential new pathways for AF risk that begin during childhood, offering new evidence to motivate smoking avoidance and cessation.

Keywords: atrial fibrillation; secondhand smoke; smoking.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / physiopathology
  • Child
  • Cohort Studies
  • Cross-Sectional Studies
  • Electrocardiography / trends
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Risk Factors
  • Tobacco Smoke Pollution / adverse effects*
  • Young Adult


  • Tobacco Smoke Pollution