Pulmonology. 2026 Dec;32(1):2640669. doi: 10.1080/25310429.2026.2640669. Epub 2026 Mar 10.
ABSTRACT
BACKGROUND: Exposure to cigarette smoke is a risk factor for endothelial dysfunction, leading to alterations in pulmonary vascular architecture and contributing to the development of pulmonary hypertension. Despite this evidence, the impact of smoking on pulmonary arterial hypertension (PAH) has only recently gained recognition.
RESEARCH QUESTION: The primary objective of this study was to further investigate the influence of cigarette smoking on the diagnosis and progression of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH).
STUDY DESIGN AND METHODS: We assessed the prevalence of cigarette smoking and analysed the demographics and clinical outcomes of ever-smokers versus never-smokers included in the Spanish Registry of Pulmonary Arterial Hypertension (REHAP).
RESULTS: A total of 1763 patients from the REHAP registry were included in the study, of whom 1293 had PAH and 450 had CTEPH. Among these, 771 patients (43.7%) were classified as ever-smokers, comprising 44% (n = 570) of those diagnosed with PAH and 42.7% (n = 201) of those with CTEPH. In PAH patients, ever-smokers were significantly older at diagnosis and study enrolment compared to never-smokers. Notably, a poorer clinical course was observed in male PAH patients who were ever-smokers, with a statistically significant association. In contrast, no significant differences in survival rates were detected between ever-smokers and never-smokers with CTEPH.
CONCLUSION: Cigarette smoking is associated with delayed diagnosis and worse survival outcomes in PAH but not in CTEPH. Male ever-smokers patients with PAH has worse prognosis than female ever-smokers. Further research is warranted to elucidate the underlying mechanisms contributing to the negative correlation between smoking and PAH.
PMID:41804599 | DOI:10.1080/25310429.2026.2640669