Heart failure & cardiomyopathies
Time to first cigarette after waking and incident heart failure: a dose-response analysis from the UK biobank
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
- Participants
- 229,391 participants
- Exposure
- TTFC categories in current smokers compared with non-smokers
- Non-smokersn = 203,653reference
- Current smokersn = 25,738
- Outcome
- Incident HF
- Follow-up
- Median 15.5 years
Methodological detailsUK Biobank, multivariable Cox proportional hazards models
- UK Biobank
- Multivariable Cox proportional hazards models
Main finding
As reported in the abstract
- 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 minTTFC <5 minvs non-smokersAdjusted; absolute risk difference of 4.03% | 2.22 (1.58–3.10) | P < 0.001 | |
| HF risk by age (subgroup), TTFC <15 minTTFC <15 min, aged <60 yearsvs non-smokers | 1.98 (1.56–2.51) | P < 0.001 | |
| HF risk by age (subgroup), TTFC <15 minTTFC <15 min, aged ≥60 yearsvs 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.
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