Smoking cessation after MI lowers mortality risk in young adults
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Young adults who quit smoking within 1 year after an MI reduced their risk for all-cause and CV mortality by more than 50%, researchers found.
“All young individuals should be counseled regarding the risk of tobacco use, but especially those who have experienced a myocardial infarction at a young age,” Ron Blankstein, MD, MSCCT, FASNC, FACC, FASPC, director of cardiac computed tomography, associate director of the cardiovascular imaging program and associate physician of preventive cardiology at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told Healio. “We must implement better programs and provide patients with the right resources — not only during their initial hospitalization, but also thereafter — and ensure that they can avoid the use of any tobacco products going forward. It’s not an easy task, but one which can result in substantial benefit to our patients.”
Partners YOUNG-MI registry
In this retrospective cohort study published in JAMA Network Open, researchers analyzed data from 2,072 patients (median age, 45 years; 81% men) from the Partners YOUNG-MI registry aged 50 years and younger who had an MI caused by atherothrombotic CAD between January 2000 and April 2016.
“While the benefits to tobacco cessation are well known, there [are] less data on how this may benefit younger individuals, particularly those who have experienced a myocardial infarction,” Blankstein said in an interview. “In fact, some studies have shown that smokers may do just as well as nonsmokers, a finding which is due to their younger age (a phenomenon that is termed the ‘smoker’s paradox’). In our study, smokers and nonsmokers had a similar age, which enabled us to more directly compare their outcomes.”
Smoking status at the index hospitalization and 1 year after MI was determined through electronic medical record review. Patients at the index hospitalization were classified as never smokers (n = 703), former smokers (n = 281) or current smokers (n = 1,088). After 1 year, those who were previously considered current smokers were further categorized into the persistent smoking group (n = 567) or cessation group (n = 343). Patients in the cessation group abstained from inhaled tobacco for at least 3 months before follow-up at 1 year without a documented relapse.
The outcome of interest was CV mortality and all-cause mortality.
Researchers used propensity score-adjusted Cox proportional hazards modeling to analyze the link between smoking cessation and both CV and all-cause mortality. For this, patients who were persistent smokers were matched to those who quit smoking.
During a median follow-up of 11.2 years, patients who quit smoking had a significantly lower rate of CV mortality (HR = 0.29; 95% CI, 0.11-0.79) and all-cause mortality (HR = 0.35; 95% CI, 0.19-0.63) compared with those who did not quit smoking. This remained statistically significant for both CV (HR = 0.19; 95% CI, 0.06-0.56) and all-cause mortality (HR = 0.3; 95% CI, 0.16-0.56) after adjustment with the propensity score and additional adjustment for hypertension, diabetes, Charlson Comorbidity Index score, peripheral vascular disease, P2Y12 inhibition at discharge and estimated glomerular filtration rate.
Benefits over time
“The results of this study demonstrate the potential magnitude of the health benefits that may be achieved over an intermediate period through smoking cessation,” Blankstein and colleagues wrote. “Furthermore, because the findings are limited to mortality and thus do not include other nonfatal events, such as cerebrovascular accidents, MIs, repeat hospitalizations, revascularization or new cancer diagnosis, the overall benefits of cessation are likely much higher.”
For more information:
Ron Blankstein, MD, MSCCT, FASNC, FACC, FASPC, can be reached at rblankstein@bwh.harvard.edu; Twitter: @ronblankstein.
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