Smoking cessation and risk of recurrent cardiovascular events and mortality after a first manifestation of arterial disease

Berg, Michel J.; Graaf, Yolanda van der; Deckers, Jaap W.; Kanter, Wanda de; Algra, Ale; Kappelle, L. Jaap; Borst, Gert J. de; Cramer, Maarten-Jan M.; Visseren, Frank L.J.

doi:10.1016/j.ahj.2019.03.019

Cited by 46 publications

(36 citation statements)

References 42 publications

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“…While the health behaviours reported and the proportion of study participants categorised as overweight and obese by BMI category in this study were equivalent to the available population normative data for a similar age range [ 47 ], this study suggests that little behaviour change occurred following stroke and presents clear opportunities to enhance secondary prevention after stroke. The levels of adherence with individual behaviours of smoking abstinence, fruit and vegetable consumption and MVPA observed in this study are in line with those reported in other studies after stroke [ 26 , 30 , 32 , 33 , 48 ]. Where the regression models employed in the current study identified predictors of one or more lifestyle-related, modifiable risk factor for recurrent events, the authors discuss these in detail below and further present a proposed decision tree for interventions to guide clinicians based on the findings of this study ( Figure 2 ).…”

Section: Discussionsupporting

confidence: 92%

“…This may represent a sub-population of stroke that are more receptive to lifestyle change and exercise participation. However, similar findings with prevalence rates of health behaviours after stroke reported in other studies/registry-based data suggest that they are broadly representative of stroke survivors in their health behaviours [ 26 , 30 , 32 , 33 ]. Similarly, the significance of the different factors considered in the current study could vary in different countries (e.g., low and low-middle income countries) and thus results may not extrapolate to all post-stroke populations.…”

Section: Discussionsupporting

confidence: 88%

“…Significantly lower engagement in healthy lifestyle behaviours is documented in stroke survivors than in matched controls [ 30 ]. Even after a life-threatening vascular event such as stroke, and lifestyle advice as routine practice, one-third of smokers continue to smoke [ 31 , 32 ]; 58% fail to meet guidelines for physical activity (PA) [ 33 ] and more than half (55%) have low fruit and vegetable consumption [ 34 ]. Physical, environmental and psychological aspects have been cited by people as barriers to engagement in healthy lifestyle after stroke [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

Lennon

Hall

Blake

2021

IJERPH

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The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

Lennon

Hall

Blake

2021

IJERPH

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“…In a study of 4673 patients with a new diagnosis of coronary artery disease in the past year, those who stopped smoking after their first adverse cardiovascular event had a lower risk of recurrent events (adjusted hazard ratio 0.66, 0.49 to 0.88) and of all cause mortality (0.63, 0.48 to 0.82) than those who continued smoking 37. A recent systematic review of psychological interventions for patients with CVD concluded that although the evidence is generally of low quality, such interventions may reduce the risk of cardiovascular mortality (relative risk 0.79, 0.63 to 0.98), but not total mortality, and improve symptoms of depression, stress, and anxiety, particularly for people with previously diagnosed psychological disorders 38…”

Section: Cardiovascular Disease and Cardiac Rehabilitationmentioning

confidence: 99%

Advances in rehabilitation for chronic diseases: improving health outcomes and function

Richardson

Franklin

Moy

et al. 2019

BMJ

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Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.

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“…To investigate the role of competing events and 'soft' endpoints on the relationship between risk factors and outcomes under the different statistical methods, several additional sensitivity analyses were performed: (1) using only non-fatal CV events; (2) including non-CV mortality in the combined endpoint; (3) using only 'hard' endpoints usually included in a composite endpoint (non-fatal MI, non-fatal stroke and CV mortality); (4) limited to 10-year follow-up; (5) limited to 5-year follow-up; (6) limited to patients included after 2007 to study a more contemporary patient population treated under the 2007 European Society of Cardiology guidelines or more recent guidelines 25 ; and (7) limited to non-smokers.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Relationship between classic vascular risk factors and cumulative recurrent cardiovascular event burden in patients with clinically manifest vascular disease: results from the UCC-SMART prospective cohort study

et al. 2021

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ObjectiveThe aim of the current study was to assess the relationship between classic cardiovascular risk factors and risk of not only the first recurrent atherosclerotic cardiovascular event, but also the total number of non-fatal and fatal cardiovascular events in patients with recently clinically manifest cardiovascular disease (CVD).DesignProspective cohort study.SettingTertiary care centre.Participants7239 patients with a recent first manifestation of CVD from the prospective UCC-SMART (Utrecht Cardiovascular Cohort - Second Manifestations of ARTerial disease) cohort study.Outcome measuresTotal cardiovascular events, including myocardial infarction, stroke, vascular interventions, major limb events and cardiovascular mortality.ResultsDuring a median follow-up of 8.9 years, 1412 patients had one recurrent cardiovascular event, while 1290 patients had two or more recurrent events, with a total of 5457 cardiovascular events during follow-up. The HRs for the first recurrent event and cumulative event burden using Prentice-Williams-Peterson models, respectively, were 1.36 (95% CI 1.25 to 1.48) and 1.26 (95% CI 1.17 to 1.35) for smoking, 1.14 (95% CI 1.11 to 1.18) and 1.09 (95% CI 1.06 to 1.12) for non-high-density lipoprotein (HDL) cholesterol, and 1.05 (95% CI 1.03 to 1.07) and 1.04 (95% CI 1.03 to 1.06) for systolic blood pressure per 10 mm Hg.ConclusionsIn a cohort of patients with established CVD, systolic blood pressure, non-HDL cholesterol and current smoking are important risk factors for not only the first, but also subsequent recurrent events during follow-up. Recurrent event analysis captures the full cumulative burden of CVD in patients.

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Smoking cessation and risk of recurrent cardiovascular events and mortality after a first manifestation of arterial disease

Cited by 46 publications

References 42 publications

Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

Advances in rehabilitation for chronic diseases: improving health outcomes and function

Relationship between classic vascular risk factors and cumulative recurrent cardiovascular event burden in patients with clinically manifest vascular disease: results from the UCC-SMART prospective cohort study

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