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smokers — so-called ever smokers — had a 21 percent higher risk. For former smokers, the relative risk was 9 percent. "One impor ta nt f inding wa s the i ncrea sed r i s k w a s s ubs t a nt i a l ly attenuated a mong former smokers, suggesting that much of the increased risk can be avoided simply by quitting smoking," Aune says. "The relative risk increased 32 percent among current smokers but 9 percent among former smokers, suggesting that nearly three- qua r ters of t he excess r isk ca n be avoided by quitting smoking. Further studies need to look at the duration of smoking cessation in relation to atria l fibrillation to clarify if the risk decreases to the level of never smokers at some point." L i ke Dr. Sol i m a n's g roup, Au ne and his co-authors believe smoking 's significant role in the development of several chronic diseases that increase atria l fibrillation risk may account for the a ssociation bet ween smok- ing and atria l fibrillation. They a lso point to nicotine's role in increasing resting heart rate, blood pressure and hy per tension, a mong other factors, as elements that could contribute to the association. MORE EVIDENCE OF SMOKING'S DELETERIOUS EFFECTS Aune ack nowledges t hat smok i ng increases risk for atria l fibrillation relatively modestly compared with the increased risk smokers face for heart attack, stroke and aortic aneurysm, but he believes his group's findings help fill in the picture of smoking's overall effects on health. Alvaro Alonso, MD, PhD, Associate Professor of Epidemiology at the Rollins School of P ublic Hea lt h at Emor y University, who was not involved in the study, says it is important to expand understanding of smoking's population- level impact, and studies like Aune's help do that. "I wouldn't consider smoking a s one of the main risk factors [for atrial fibrillation]," Dr. Alonso says. "We know other things, like hypertension and obesity, are much stronger predictors of atrial fibrillation and stronger risk factors for it, but that does not diminish the importance of smoking cessation because [smoking] is a risk factor for many other cardiovascular diseases." Aune says the meta-ana lysis could have an impact on the smoking habits of certain groups of patients. "[C ]l i n ic a l pr a c t ic e g u ide l i ne s already encourage smoking cessation among smokers and avoiding tobacco smoking among nonsmokers," he says. "Nevertheless, ... the findings might encourage patients [at] particularly high risk of atria l fibrillation to stop smoking or avoid starting smoking." n Meeting the mental health needs of Kansas The Psychiatry & Behavioral Sciences Department at KU School of Medicine-Wichita takes pride in providing exemplary education and bringing compassionate, cutting-edge care to patients. Our faculty partner with our community and state to provide outstanding training for our learners and make excellent clinical care accessible to all. We Doctor Kansas. Call today for more information: 316-293-2669. wichita.kumc.edu/psychiatry-and-behavioral-sciences.html M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 019 1 3