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A tragic triad: coronary artery disease, nicotine addiction, and depression

Anne N Thorndike1, Nancy A Rigotti

  • 1General Medicine Division, Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. athorndike@partners.org

Current Opinion in Cardiology
|June 25, 2009
PubMed

Insights

Smokers with cardiovascular disease (CVD) who are depressed are more likely to resume smoking after hospitalization. Intensive, long-term counseling and pharmacotherapy are recommended for smoking cessation in this population.

Area of Science:

  • Cardiology
  • Psychiatry
  • Public Health

Background:

  • Continued smoking significantly increases risks for patients with cardiovascular disease (CVD).
  • Depression is prevalent in CVD patients and linked to poor adherence to cardiac risk reduction strategies.
  • Most smokers with CVD resume smoking post-hospitalization despite available treatments.

Purpose of the Study:

  • To review the intricate relationship between smoking and depression in cardiovascular disease (CVD) patients.
  • To examine current evidence for interventions targeting this triad of smoking, depression, and CVD.
  • To identify effective strategies for smoking cessation in hospitalized CVD patients with depressive symptoms.

Main Methods:

  • Systematic review of smoking interventions in hospitalized patients.
  • Analysis of secondary data on treatment efficacy for smokers with depression and CVD.
  • Literature review on the association between depressive symptoms and smoking relapse in CVD patients.

Main Results:

  • Depressive symptoms affect 22-24% of smokers hospitalized with CVD.
  • Smokers with depression experience more intense nicotine withdrawal and higher relapse rates.
  • Intensive counseling exceeding one month and potentially bupropion SR or CBT show promise for cessation.

Conclusions:

  • Screening for depression in CVD smokers, especially during acute events, is crucial.
  • Hospitalized CVD smokers require extended (>1 month) intensive counseling for cessation.
  • Prolonged treatment, possibly including pharmacotherapy, is needed for depressed CVD smokers to quit smoking.
Abstract

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