Heart failure & cardiomyopathiesCohort study
Time to first cigarette after waking and incident heart failure: a dose-response analysis from the UK biobank
- prospective cohort
- UK Biobank
- multivariable Cox proportional hazards models
Authors' conclusion
Shorter TTFC is independently and dose-dependently associated with a higher risk of incident HF, even after accounting for smoking burden and comorbidities. TTFC assessment may improve HF risk stratification, particularly in younger individuals.
Study context
- Population
- Participants from the UK Biobank; current smokers categorized by time to first cigarette after waking (TTFC)participants from the UK Biobank · non-smokers 203,653 · current smokers 25,738
- Participants
- 229,391 participants
- Exposure
- TTFC categories in current smokers compared with non-smokers
- non-smokersn = 203,653reference
- current smokersn = 25,738
Main finding
As reported in the abstract
Incident HF · median follow-up of 15.5 years
- incident heart failure (HF) cases among 229 391 participants
- 6912 (3.01%)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF risk, TTFC <5 min · adjusted; absolute risk difference of 4.03% | 2.22 (1.58–3.10) | P < 0.001 | |
| HF risk by age (subgroup), TTFC <15 min — TTFC <15 min, aged <60 years vs non-smokers | 1.98 (1.56–2.51) | P < 0.001 | |
| HF risk by age (subgroup), TTFC <15 min — TTFC <15 min, aged ≥60 years vs non-smokers | 1.55 (1.25–1.91) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
- HF risk by age (subgroup), TTFC <15 min: P for interaction <.001
HF risk by TTFC (dose-response)
- Significant dose-dependent relationship between shorter TTFC and HF risk
- P for trend < 0.001
HF risk, joint analysis of TTFC with daily cigarette amount
- ≤median cigarettes/day, across decreasing TTFC categories: HR from
- 1.61 (95% CI: 1.35-1.92; P < .001) to 2.25 (1.86-2.72; P < .001)
- >median cigarettes/day: HRs ranged from
- 1.95 (1.41-2.69; P < .001) to 2.17 (1.74-2.69; P < .001)
- Similar gradients when TTFC was jointly analysed with smoking duration
Original publication
Time to first cigarette after waking and incident heart failure: a dose-response analysis from the UK biobank. ESC Heart Fail. Published 18 February 2026. doi:10.1093/eschf/xvag049
Summarised from the published abstract; every number is checked against it