Physicians typically use medication to treat patients suffering from congestive heart failure. But a study published in the May 2001 issue of the Journal of the American College of Cardiology //suggests that getting these patients to stop smoking can have just as powerful an impact on their health as drugs.
"Even when patients have had significant heart damage from previous heart attacks and are currently in heart failure, stopping smoking is still very important and prolongs lives," explained lead author Dr. Neville Suskin, of the London Health Sciences Centre in London, Ontario. "It's never too late."
Drawing on data from 6,704 patients enrolled in the Studies of Left Ventricular Dysfunction Prevention and Intervention trials, Dr. Suskin and his colleagues compared the health of current smokers to ex-smokers who quit less than two years before, ex-smokers who quit more than two years before, and never-smokers.
The researchers weren't surprised to find that current smokers had a significantly higher rate of heart attacks, recurrent heart failure, and death than never-smokers and ex-smokers. What did surprise them was the fact that there were no significant differences in heart attack, recurrent heart failure, and death rates between ex-smokers and never-smokers, even after they accounted for baseline differences among the patients. Ex-smokers and never-smokers both had a 30-percent lower risk of dying than current smokers, a reduction in mortality similar to that achieved by angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and other drugs commonly used to treat heart failure.
In a related editorial, Drs. James Lightwood, Kirsten E. Fleischmann, and Stanton A. Glantz, of the University of California at San Francisco, applauded the study for dispelling the myth that smokers are a lost cause. "Cardiologists need to incorporate aggressive efforts to promote smoking cessation into practice in the same w
ay they have incorporated ACE inhibitors and beta-blockers," they wrote, citing research showing that only 46 percent of smokers who see their physicians in a given year are advised to quit and only 15 percent are offered smoking cessation therapy. "To do anything else would be to deny these patients the best care."
Promoting smoking cessation could also help rein in spiraling health care costs, added Dr. Sidney Goldstein, of Henry Ford Hospital in Detroit. "At a time when we're struggling with the cost of pharmaceutical coverage for patients with chronic heart disease, we tend to lose sight of the importance of smoking cessation," he said. "It's an important preventive measure for morbidity and mortality in heart failure, which can be achieved at little or no cost."
The American College of Cardiology, a 26,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.
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