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Smoking Trajectories and Residual Cardiovascular Risk in Patients with Stable Coronary Artery Disease: An
Jules Mesnier1,2,3, Louis Giovachini1, Grégory Ducrocq1,2,3
1Université de Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, France.
Insights
Quitting smoking significantly improves cardiovascular outcomes in stable coronary artery disease (CAD) patients, regardless of when they stop. Reducing smoking quantity, however, did not show similar benefits for cardiovascular health.
Area of Science:
- Cardiology
- Public Health
- Smoking Cessation Research
Background:
- Smoking is a major risk factor for cardiovascular disease.
- Understanding the impact of smoking cessation and reduction in stable coronary artery disease (CAD) patients is crucial for improving long-term outcomes.
- Existing research has not fully clarified the benefits of quitting or reducing smoking in this specific patient population.
Purpose of the Study:
- To investigate the impact of smoking cessation and reduction on long-term cardiovascular (CV) events in stable CAD patients.
- To determine if quitting smoking at any stage offers significant benefits and to quantify these benefits.
- To analyze the relationship between smoking habits and residual CV risk in former smokers.
Main Methods:
- Utilized data from the CLARIFY registry, including 32,378 outpatients with stable CAD.
- Recorded smoking history and status annually over a 5-year follow-up period.
- Analyzed the effects of smoking cessation and reduction in active smokers, and the timing of cessation in former smokers on the primary outcome (CV death and MI).
Main Results:
- Smoking cessation in active smokers was associated with significantly improved CV outcomes, irrespective of the timing of quitting (aHR 0.56).
- Reducing smoking quantity was not associated with improved cardiovascular outcomes.
- Each additional year of smoking post-CAD diagnosis increased CV risk, and former smokers did not reach the CV risk level of never smokers.
Conclusions:
- Smoking cessation is a priority for stable CAD patients, offering significant improvements in CV outcomes and survival regardless of cessation timing.
- Smoking reduction alone does not appear to improve cardiovascular outcomes in this population.
- Early smoking cessation, ideally within a year of CAD diagnosis, is critical to mitigate long-term cardiovascular risk.
Background And Aims:
There is a variety of smoking habits trajectories in patients with established stable coronary artery disease (CAD), with unclear consequences on cardiovascular (CV) events. We aimed to clarify the impact of smoking cessation and reduction on long-term cardiovascular outcomes in stable CAD patients, evaluating whether quitting at any stage still provides significant benefits and to what extent.
Methods:
The CLARIFY registry included 32,378 outpatients with stable CAD. Smoking history and status were recorded annually during the 5-year follow-up. In active smokers, we studied the effect of smoking cessation or reduction. In former smokers, we analysed the timing of smoking cessation relative to CAD diagnosis and residual CV risk based on years of abstinence. The primary outcome was a composite of CV death and MI.
Results:
At inclusion, 46.2% of patients were former smokers and 12.5% current smokers. Amongst active smokers, smoking cessation in the stable phase of the disease was associated with improved outcomes, irrespective of timing (aHR 0.56, 95%CI 0.42-0.76, p<0.001). However, smoking quantity reduction was not associated with improved CV outcomes. Among former smokers, 55.7% had quit within a year of CAD diagnosis. Each additional year of smoking post-CAD diagnosis increased CV risk. Former smokers never returned to the CV risk level of never smokers, regardless of years of abstinence.
Conclusions:
In stable CAD patients, smoking cessation is associated with significantly better CV outcomes and survival, irrespective of timing of cessation, and should therefore always be a priority. Smoking reduction was not associated with improved CV outcomes. Most former smokers quit within a year of CAD diagnosis, and CV risk increase with each subsequent year of active smoking.
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