Effect of smoking on thrombotic antiphospholipid syndrome: a 10-year prospective cohort study

Hui Jiang; Can Huang; Yu Shi; Chu-Han Wang; Si-Yun Chen; Jun Li; Qian Wang; Meng-Tao Li; Xin-Ping Tian; Xiao-Feng Zeng; Yan Zhao; Jiu-Liang Zhao

doi:10.1093/rheumatology/kead498

Effect of smoking on thrombotic antiphospholipid syndrome: a 10-year prospective cohort study

Rheumatology (Oxford). 2023 Sep 20:kead498. doi: 10.1093/rheumatology/kead498. Online ahead of print.

Authors

Hui Jiang¹, Can Huang^{1

2}, Yu Shi¹, Chu-Han Wang¹, Si-Yun Chen¹, Jun Li¹, Qian Wang^{1

2

3

4}, Meng-Tao Li^{1

2

3

4}, Xin-Ping Tian^{1

2

3

4}, Xiao-Feng Zeng^{1

2

3

4}, Yan Zhao^{1

2

3

4}, Jiu-Liang Zhao^{1

2

3

4}

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
² National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, Beijing, China.
³ State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁴ Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing.

PMID: 37738261
DOI: 10.1093/rheumatology/kead498

Abstract

Objectives: Cigarette smoking is an established risk factor for autoimmune diseases. However, whether smoking plays a clear role in thrombotic antiphospholipid syndrome (TAPS) has not been determined. We aimed to investigate the effects of smoking on clinical characteristics and prognosis of TAPS.

Methods: This was a prospective cohort study from 2013 to 2022. During the study period, 297 patients were diagnosed with TAPS, including 82 smokers and 215 non-smokers. After propensity score matching, 57 smokers and 57 non-smokers matched by age and sex were analysed.

Results: Overall, smokers with TAPS had more cardiovascular risk factors (CVRFs) than non-smokers, including hypertension (36.59% vs. 14.42%, P<0.001), obesity (15.85% vs. 7.44%, P=0.029), dyslipidaemia (64.63% vs. 48.37%, P=0.012), and hyperhomocysteinaemia (62.20% vs. 36.28%, P<0.001). Arterial thrombotic events were more common in smokers at diagnosis (62.20% vs. 46.05%, P=0.013), especially myocardial infarction, visceral thrombosis, and peripheral vascular thrombosis. After matching, smokers showed balanced CVRFs with non-smokers at baseline, but retained a higher prevalence of arterial thrombosis (59.65% vs. 33.33%, P=0.005), mainly distributed in cerebral vascular, cardiovascular, and retinal vascular territories. During follow-up, smokers presented a tendency for more recurrent arterial thrombosis and less recurrent venous thrombosis. Smokers had significantly poorer outcomes for organ damage with higher DIAPS (median, 2.00 vs. 1.00, P=0.008), especially in the cardiovascular (26.32% vs. 3.51%, P=0.001), gastrointestinal (15.79% vs. 1.75%, P=0.016), and ophthalmologic (10.53% vs. 00.00%, P=0.027) systems.

Conclusion: Smoking is related to increased arterial events and poor prognosis in TAPS patients. Patients with TAPS should be fully encouraged to avoid smoking.

Keywords: antiphospholipid syndrome; cigarette smoking; outcomes; thrombosis.