Smoking cessation benefit on ASCVD as effective as 3 meds?

Patients with atherosclerotic cardiovascular disease (ASCVD) who quit smoking after acute coronary syndrome or revascularization have a comparable gain in event-free years as those who are on maximal pharmaceutical treatment, according to a study presented at the ESC Preventive Cardiology 2022 annual congress.

“Our study shows that kicking the [smoking] habit appears to be as effective as taking three medications for preventing heart attacks and strokes in those with a prior heart attack or procedure to open blocked arteries. Patients could gain nearly 5 years of healthy life,” pointed out study author Dr Tinka Van Trier from the Amsterdam University Medical Centre, Amsterdam, the Netherlands.

Using data obtained from the prospective RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V, and HELIUS studies, the researchers identified 989 patients aged ≥45 years (mean age 60 years, 23 percent female) with established ASCVD who were receiving treatment with statins, antihypertensive drugs, and antiplatelet drugs. All included patients were persistent smokers at ≥6 months (median 1.2 years) after experiencing acute coronary syndrome or revascularization.

The primary outcome of interest was the estimated gain in years without a myocardial infarction (MI) or stroke, as measured through the SMART-REACH model, between patients who stopped smoking and those who persisted smoking while on maximal pharmaceutical treatment (≥1 of bempedoic acid, colchicine, and PCSK9 inhibitors).

At assessment, patients who quit smoking had a comparable estimated gain in years sans MI or stroke as those who persisted smoking while on maximal pharmaceutical therapy (mean 4.81 vs 4.83 event-free years). [ESC Preventive Cardiology 2022, Moderated posters session 1 – Secondary Prevention and Rehabilitation]

“This analysis focused on smokers who had experienced a heart attack and/or undergone stent implantation or bypass surgery. This group is at particularly high risk of having another heart attack or a stroke and stopping smoking is potentially the most effective preventive action,” said Van Trier.

“[The results] indicate that smoking cessation is a very important step towards adding healthy years to one’s lifetime,” she said. “The benefits of smoking cessation are even greater than we realized.”

“Smoking cessation remains a cornerstone of preventing heart attacks and strokes and improving overall health at any time, including after a heart attack and at any age. We know that cigarette smoking is responsible for 50 percent of all avoidable deaths in smokers, of which half are due to cardiovascular disease,” she continued.

Van Trier pointed out that the benefits noted in this study only applied to MI and stroke and did not take into account the further benefits of smoking cessation on other conditions such as respiratory disease and cancer.

She recommended that individuals who want to quit smoking should consult their healthcare professionals. “[M]otivation is key to successfully quitting, but beating an addiction becomes easier with medical and psychological assistance,” she noted.