Smoking history and pulmonary arterial hypertension: Demographics, onset, and outcomes

Adaani E. Frost, Carol Zhao, Harrison W. Farber, Raymond Benza, Joseph Yen, Mona Selej, C. Gregory Elliott

Research output: Contribution to journalArticlepeer-review


Background: Smoking prevalence and its association with pulmonary arterial hypertension (PAH) outcomes have not been described in patients in the United States. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)377-389
Number of pages13
JournalJournal of Heart and Lung Transplantation
Issue number3
StatePublished - Mar 2023


  • demographics
  • outcomes
  • prevalence
  • pulmonary arterial hypertension
  • REVEAL registry
  • smoking
  • Prevalence
  • Humans
  • Male
  • Hypertension, Pulmonary
  • Familial Primary Pulmonary Hypertension
  • Smoking/adverse effects
  • Pulmonary Arterial Hypertension
  • United States/epidemiology
  • Female
  • Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Transplantation
  • Pulmonary and Respiratory Medicine
  • Surgery


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