Smoking Cessation for Patients with Cardiovascular Disease

Abstract

Tobacco use remains the major preventable cause of early mortality and morbidity in the US and is a major risk factor for cardiovascular disease (CVD). Quitting smoking rapidly reduces the risk of cardiovascular events. In this review, we identify and discuss best approaches to assist smoking cessation among patients with CVD. Establishing office systems that reliably identify smokers to healthcare providers is an essential first step. Once the patient is identified as a smoker, providers should inquire about their willingness to quit and advise them to quit or provide motivation to get ready to make a quit attempt. Behavioral (counseling) and pharmacologic (nicotine replacement and non-nicotine medications) treatments double or triple long-term cessation rates and should be offered in combination to all patients with CVD who use tobacco. More intensive behavioral therapy is more effective and should be delivered when possible. The choice of pharmacotherapy will depend upon the clinical history of the patient and patient preference. Nicotine replacement and sustained release bupropion (bupropion SR) are first-line treatments for smoking cessation. Nicotine patches have been studied extensively in patients with stable CVD and have been shown to be safe. Bupropion SR has relatively few cardiovascular adverse effects and may be especially useful for patients with CVD; its safety is currently being studied. Special consideration is needed for hospitalized patients with acute coronary syndromes (e.g. myocardial infarction and unstable angina). The safety of pharmacotherapy in the acute setting is not yet established. Behavioral interventions, however, are very effective and should be delivered to all hospitalized smokers. Finally, it is important to create a clinical environment that is supportive of treating patients with tobacco dependence. Simple changes in office and hospital routines and procedures (routine screening to identify smokers, prompts to encourage intervention and links to more intensive tobacco dependence treatment programs) will substantially improve the identification, treatment, and outcomes of patients with CVD who use tobacco.

Bupropion for Smoking Cessation in Patients With Acute Coronary Syndrome

“…In our study, in which the findings are in agreement with those of others, no notable change in blood pressure was documented. 21 Weight gain, which is a common bothersome problem during tobacco withdrawal, 22 was not documented in this study in either group. In a recently published review, bupropion was found to limit postcessation weight gain at the end of treatment but had no long-term effect.…”

Income-related inequality in smoking cessation among adult patients with cardiovascular disease: a 5-year follow-up of an angiography intervention in Luxembourg

“…Many factors are associated with the continuation of smoking among cardiac patients: younger patient age, higher level of nicotine dependency, lack of future intentions to quit [1], lack of will or confidence, absence of social support [12], belief that “the damage is done,” history of smoking relapse, hostility [13], and absence of smoking cessation advice [10, 14]. Furthermore, Berndt et al [1] distinguished three types of hospitalised cardiac patients according to their smoking characteristics and predictors of smoking abstinence 1 month after discharge.…”

Adverse Childhood Experiences and Smoking Persistence in Adults with Smoking-Related Symptoms and Illness

“…Quit rates among those with cardiovascular disease do not exceed quit rates for the general population. 4 Similarly, about one-third of patients with cancer continue to smoke after diagnosis. 5,6 Understanding why some patients seem to have greater diffi-culty quitting may improve the practice of medicine.…”