Long-term smoking cessation and heart rate dynamics in an aging healthy cohort: Is it possible to fully recover?

To evaluate the long-term influence of smoking cessation on the regulation of the autonomic cardiovascular system in an aging general population, using the subpopulation of lifelong non-smokers as control group. We analyzed 1481 participants aged ≥50 years from the SAPALDIA cohort. In each participant, heart rate variability and heart rate dynamics were characterized by means of various quantitative analyzes of the inter-beat interval time series generated from 24-hour electrocardiogram recordings. Each parameter obtained was then used as the outcome variable in multivariable linear regression models in order to evaluate the association with smoking status and time elapsed since smoking cessation. The models were adjusted for known confounding factors and stratified by the time elapsed since smoking cessation. Our findings indicate that smoking triggers adverse changes in the regulation of the cardiovascular system, even at low levels of exposure since current light smokers exhibited significant changes as compared to lifelong non-smokers. Moreover, there was evidence for a dose–response effect. Indeed, the changes observed in current heavy smokers were more marked as compared to current light smokers. Furthermore, full recovery was achieved in former smokers (i.e., normalization to the level of lifelong non-smokers). However, while light smokers fully recovered within the 15 first years of cessation, heavy former smokers might need up to 15–25 years to fully recover. This study supports the substantial benefits of smoking cessation, but also warns of important long-term alterations caused by heavy smoking. •We assess HRV and heart rate dynamics after long-term smoking cessation.•Light smokers fully recover within the 15 first years of cessation.•Heavy former smokers might need up to 15–25 years to fully recover.•This study supports the substantial benefits of smoking cessation.•It also warns of important long-term alterations caused by heavy smoking.