persistent smoking

Almost 60% of patients who survive coronary heart disease continue as persistent smokers. Scientists aimed to identify the risk factors of persistent smoking after a heart attack.

The role that cigarette smoking has played in the initiation and progression of heart disease has been extremely researched over the years. It’s known that smoking is the leading cause of death in first world countries and significantly increases the risk of heart disease. Due to this fact, smoking seems to be a crucial risk factor that has to be targeted to try and advance prognosis for coronary heart disease. There are different programs and treatments that may be used to help curb smoking after a heart attack. Although half of the patients who have survived coronary heart disease in Europe persist with daily smoking, not much is known about the qualities and risk factors of the patients who continue with persistent smoking versus those that don’t.

A research study by Elise Sverre and colleagues, published in BMC Cardiovascular Disorders, aimed to identify the modifiable factors of persistent smoking after coronary heart disease events in patients. This study looked at medical history and sociodemographic factors, as well as psychological factors that may affect coronary heart disease patients who continue with persistent smoking. This was a cross-sectional study that included 1,083 patients. The patients were aged anywhere between 18-80 years old, with an occurrence of a coronary heart event.

The main outcome variable used was the smoking status of a patient at their follow-up appointment. This was reported from a questionnaire that patients filled out. Persistent smokers were categorized as those who smoked daily. Many variables were recorded at the time of the initial hospitalization and anywhere between 2-36 months following the initial hospitalization. These included demographics and risk factors as initial index variables, and marital status, education, employment status, coronary risk factor, and medication as follow-up variables.

At follow-up, it was reported that 43% of patients had quit smoking while the rest continued smoking. During analysis, the researchers found that unemployment/disability benefits, lower education, and a longer smoking period prior to coronary heart disease were significantly correlated to persistent smoking following survival of coronary heart disease. Furthermore, Patients who did not experience heart attacks as their coronary event were more likely to continue smoking.

It seems that there is a very real correlation with smoking and socioeconomic status. Although there is not much that can be done to change one’s socioeconomic status, there is a way that clinicians may be able to intervene with high-risk patients. These patients could be identified during their initial hospitalization and offered either a program that helps in quitting smoking or some sort of treatment. One piece of valuable information that this study didn’t address was the spectrum that patients were at in their quitting journey. A surprising result that came out of this study was that no psychological factors played a role in the correlation between quitters or persistent smokers after a coronary heart disease. One limitation of this study was that all study factors were self-reported through questionnaires, and as such could be biased by memory.

One important result of this study was that while they continued to smoke after their coronary event, as many as 73% of smokers reported reducing their smoking and up to 70% of them requested immediate assistance to quit.  This indicates that even persistent smokers are highly motivated to quit after a coronary event, and that smoking cessation programs should target this group specifically.

In conclusion, low socioeconomic status and not having a heart attack as a coronary heart event were factors that were correlated with persistent smoking in patients following a coronary heart event, while psychological factors had no correlation. Given the fact that quitting smoking is extremely beneficial in reducing risks associated with heart disease, it seems that there is potential in developing programs and interventions that may help this, especially for patients that are at high risk for persistent smoking following a coronary heart event.

Written by Ingrid Qemo, BSc.

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