Systematic approaches to smoking cessation in the cardiac setting

Constituents of tobacco smoke are prothrombotic and atherogenic and causative factors in the development of coronary heart disease (CHD). Smoking cessation is the single most important intervention to reduce morbidity and mortality in smokers with CHD. This review presents contemporary information regarding treatments for smoking cessation in the setting of CHD.

The beneficial effects of smoking cessation may be mediated by improvements in endothelial function. Failure to quit smoking in those with CHD is a typical consequence of nicotine addiction. Practical counseling and pharmacotherapy [nicotine replacement therapy (NRT), bupropion, and varenicline] are well tolerated and effective treatments for CHD patients attempting to quit smoking. Treatments initiated in hospital following a CHD-related event or procedure are more effective than those initiated outside the hospital setting. Extending medication use beyond the initial treatment phase is the most promising means of preventing relapse. Financial coverage for smoking cessation pharmacotherapy improves quit rates. The routine provision of pharmacotherapy and practical counseling in the CHD setting can be assured by implementing proven, systematic approaches to smoking cessation treatment.

Smoking cessation is a fundamental priority in smokers with CHD. Systematic approaches to ensure that cessation assistance is provided by clinicians and to improve cessation outcomes for smokers are effective and available.