Many With Coronary Disease Continue to Smoke Despite Physicians’ Advice
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Coronary disease is not always a wake-up call for smokers.
One in five European patients with established coronary heart disease keeps smoking despite physicians’ efforts to get them to quit, according to an international multicenter survey.
Patients with angina, minimal education, and who were younger were more likely to continue smoking compared with patients who had had a heart attack, were older, and had more education, investigators reported in the October issue of the European Heart Journal.
These findings emerged on the basis of two international surveys. The first, known as the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE), was conducted in 1996. Results from a second EUROASPIRE survey—a follow-up study from 1999-2000—found that physicians had hardly made a dent in reducing smoking rates in this high-risk patient population.
The prevalence of smoking in patients with established coronary heart disease “did not change in the five-year period between the two EUROASPIRE surveys and remained at a high level,” said Wilma Scholte op Reimer, Ph.D., an epidemiologist at Erasmus Medical Center here.
Because smoking remains a top risk factor not only for cardiovascular disease, but also for cancer and chronic obstructive pulmonary disease, she said, “time and effort should continuously be spent to support stop smoking in these individuals.”
The second EUROASPIRE survey included 5,551 patients, up to age 70, recruited from 47 hospitals in 15 European countries. They were interviewed about 16 months after being admitted to the hospital for coronary-bypass surgery, myocardial infarction, myocardial ischemia, or percutaneous transluminal coronary angioplasty.
All patients were interviewed about lifestyles, including questions about smoking habits. Smoking status was confirmed by a carbon monoxide breath analyzer test. The results from this second survey were then compared with those of the first survey. The two surveys involved different groups of patients.
According to the second survey, 1,172 patients (21%) still smoked at the time of the interview compared with 19% of the participants in the first survey.
Younger patients appeared to have more trouble kicking the habit. Of those younger than 50, 39% continued to smoke compared with 26% of patients ages 50 to 60, and 14% of those 60 and older. Gender was not a factor. Smokers with angina were less likely to quit than those who had had a heart attack (38% versus 52%, respectively), the authors reported.
The researchers also found that 99% of 2,244 patients in this survey had received verbal advice to quit smoking from a medical professional before experiencing the coronary event that brought them to the hospital. Almost half (48%) stopped smoking after their coronary event, although many patients eventually relapsed. In this group, 53% of those 60 and older had quit compared with only 41% of those under age 50.
Education was also a factor: 56% of patients with a university education had quit.
Those who successfully quit smoking, the authors added, also made other positive lifestyle changes compared with the smokers. Though most patients received verbal advice to quit, only 26% received written advice. Interestingly, 20% of the ex-smokers received written advice compared with 30% of the refractory patients. The authors admitted they were puzzled by this finding. It is possible, they said, that patients who stopped had already made up their minds to do so and so ignored the printed document when offered.
Although these findings are based on self-reported data, the study dramatically demonstrates that physicians have their work cut out for them, the authors concluded.
“Preventive cardiology regarding smoking cessation has not improved since 1996,” they wrote. The findings highlight the need for “more intensive, effective smoking cessation programs,” perhaps ones that target younger patients, those with less education, and those with angina.
One potential limitation of the study, noted by the authors, is that the EUROASPIRE surveys were conducted mainly in university hospital settings and may not be representative of what takes place in the primary-care setting.
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