Smoking prevalence and its association with pulmonary arterial hypertension (PAH) outcomes have not been described in patients in the United States.
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.
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.
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.
Abbreviations:6MWD (6-minute walk distance), APAH (associated pulmonary arterial hypertension), BNP (brain natriuretic peptide), CI (confidence interval), COPD (chronic obstructive pulmonary disease), COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension), DLCO (diffusion capacity for carbon monoxide), eGFR (estimated glomerular filtration rate), ERA (endothelin receptor antagonist), FEV1 (forced expiratory volume in 1 second), FPAH (familial pulmonary arterial hypertension), FVC (forced vital capacity), HIV (human immunodeficiency virus), HR (hazard ratio), IPAH (idiopathic pulmonary arterial hypertension), IQR (interquartile range), mPAP (mean pulmonary arterial pressure), n/a (not applicable), NC (not calculated), OSA (obstructive sleep apnea), PAH (pulmonary arterial hypertension), PCWP (pulmonary capillary wedge pressure), PDE5i (phosphodiesterase 5 inhibitor), PH (pulmonary hypertension), PoPH (portopulmonary hypertension), PPH (primary pulmonary hypertension), PVOD (pulmonary veno-occlusive disease), PVR (pulmonary vascular resistance), RAP (right atrial pressure), REVEAL (Registry to Evaluate Early and Long-term PAH Disease Management), RHC (right heart catheterization), SD (standard deviation), WHO (World Health Organization)
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Published online: October 17, 2022
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