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Smoking cessation rates failed to increase with carotid plaque screening
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Carotid plaque screening, along with thorough smoking cessation counseling, did not increase rates of smoking cessation or control CV risk factors among participants who smoked, according to data from a recent study.
Researchers randomly assigned 267 participants to a carotid plaque screening group and 269 participants to a control group (mean age, 51.1 years; 45% women). All participants received 20-minute individual counseling sessions, one telephone call at 6 months, brochures on smoking cessation and nicotine replacement therapy.
The primary outcome assessed whether smoking cessation rates at 12 months improved through carotid plaque screening. Based on Framingham risk scores, the secondary outcome tested whether carotid plaque screening improved CV risk factors and overall 10-year CV risk.
At 12 months, smoking cessation rates did not differ between the carotid plaque screening (24.9%) and control groups (22.1%; P=.45). In intention-to-screen analysis, the cessation rate did not differ between the screening (24.9%; 95% CI, 19.7-30.1) and control groups (20.2%; 95% CI, 17.1-27.1) for point prevalence abstinence. Similar results were found for continuous smoking abstinence (20.4%; 95% CI, 15.5-25.2 vs. 20.2%; 95% CI, 15.4-25).
BP and levels of LDL, HbA1c and high-sensitivity CRP did not differ between the two groups at 12 months, according to study results. Cessation rates in a preplanned subgroup analysis among the carotid plaque screening group did not differ among participants with (95% CI, 18.7-32.6) and without (95% CI, 16.2-32) carotid plaques. Researchers also found a similar change in CV risk factors. However, LDL levels had a larger decrease in participants with plaques (–8.1 mg/dL) vs. without (+3.9 mg/dL; P=.004).
To motivate patients toward lifestyle changes, patient–physician communication and relationships must be established, according to Patrick G. O’Malley, MD, MPH, of the division of general internal medicine at the Uniformed Services University. In an accompanying editorial, O’Malley recommended implementing communications skills programs in medical education to achieve “a mastery level of competence among graduating and practicing physicians.”
“There are no simple solutions to motivating patients,” O’Malley wrote in the editorial. “A picture may be worth a thousand words, but relationships move mountains when it comes to transformative personal change.”
For more information:
- O’Malley P. Arch Intern Med. 2012;doi:10.1001/archinternmed.2011.1948.
- Rodondi N. Arch Intern Med. 2012;doi:10.1001/archinternmed.2011.1326.
Disclosure: The researchers and Dr. O’Malley report no relevant financial disclosures.
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Although the ultrasound pictures did not seem to reduce smoking rates, the smoking cessation advice that was provided resulted in nearly one in four participants successfully quitting smoking over the 12 month follow-up period. This is much higher than would be expected in routine clinical care. Although not the primary reason for this study, it demonstrates that aggressive behavioral counseling can achieve meaningful changes. This success underscores the need for physicians to emphasize to patients just how important behavioral changes are. I think most would be surprised at how effective this can be.
– Todd M. Brown, MD, MSPH, FACC
Assistant
Professor of Medicine
University of Alabama at Birmingham
Disclosure: Dr. Brown reports no relevant financial disclosures.
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