| Title: | Time to first cigarette after waking and incident heart failure: a dose-response analysis from the UK biobank |
| Journal: | ESC Heart Failure |
| Published: | 3 Feb 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41711245/ |
| DOI: | https://doi.org/10.1093/eschf/xvag049 |
Publication 18379
WARNING: the interactive features of this website use CSS3, which your browser does not support. To use the full features of this website, please update your browser.
Abstract
BACKGROUND AND AIMS: We aimed to investigate the association between time to first cigarette after waking (TTFC) and incident heart failure (HF) in a large prospective cohort.</p>
METHODS: This study included 229 391 participants from the UK Biobank. Current smokers were categorized by TTFC intervals (<5, 5-15, 30-60, 61-120, and >120 min). Multivariable Cox proportional hazards models were employed to assess the relationship between TTFC and HF. Joint analyses evaluated the combined associations of TTFC with daily cigarette amount and smoking duration. Subgroup and interaction analyses were conducted by age, sex, BMI, education, and alcohol consumption.</p>
RESULTS: During a median follow-up of 15.5 years, 6912 (3.01%) incident HF cases occurred among 229 391 participants. The cohort included 203 653 (88.77%) non-smokers (age 55.9 ± 8.1 years, 41.4% female, 91.5% White ethnicity, 2.7% incident HF cases) and 25 738 (11.23%) current smokers (age 54.5 ± 8.1 years, 49.0% female, 89.1% White ethnicity, 5.7% incident HF cases). A significant dose-dependent relationship was observed between shorter TTFC and HF risk (P for trend <.001). Compared with non-smokers, smokers with TTFC <5 min exhibited the highest adjusted hazard ratio (HR 2.22, 95% CI 1.58-3.10; P < .001), corresponding to an absolute risk difference of 4.03%. Joint analyses showed that among individuals smoking ≤median cigarettes/day, HF risk increased from HR 1.61 (95% CI: 1.35-1.92; P < .001) to 2.25 (1.86-2.72; P < .001) across decreasing TTFC categories; among those smoking >median cigarettes/day, the corresponding HRs ranged from 1.95 (1.41-2.69; P < .001) to 2.17 (1.74-2.69; P < .001). Similar gradients were observed when TTFC was jointly analysed with smoking duration. Subgroup analyses indicated stronger associations in participants aged <60 years (HR 1.98, 95% CI 1.56-2.51; P < .001 for TTFC <15 min) than in those ≥60 years (HR 1.55, 95% CI 1.25-1.91; P < .001), both compared with non-smokers (P for interaction <.001).</p>
CONCLUSIONS: Shorter TTFC is independently and dose-dependently associated with a higher risk of incident HF, even after accounting for smoking burden and comorbidities. TTFC assessment may improve HF risk stratification, particularly in younger individuals.</p>
16 Keywords
- Adult
- Aged
- Biological Specimen Banks
- Female
- Follow-Up Studies
- Heart Failure
- Humans
- Incidence
- Male
- Middle Aged
- Prospective Studies
- Risk Factors
- Smoking
- Time Factors
- UK Biobank
- United Kingdom
9 Authors
- Jiahua Wen
- Zhaohan Yan
- Yue Cao
- Huisong Ma
- Yunying Zeng
- Ling Zhao
- Jianzhao Su
- Yunzhao Hu
- Yuli Huang
1 Application
| Application ID | Title |
|---|---|
| 356978 | The Association of TyG Index with Morbidity and Mortality of Cardiovascular Diseases. |
Enabling scientific discoveries that improve human health