Transcript CVD-ML3-FINAL Importance of Cessation in

SMOKING CESSATION
FOR CVD PATIENTS
Mini Lecture 3
Module: Effects of Tobacco on the
Cardiovascular System
Objectives of the Mini Lecture
GOAL OF MINI LECTURE: Provide students with
knowledge about the benefits of smoking cessation
particularly in reducing CVD burden.
LEARNING OBJECTIVES
Learners will be able to:
• Describe the beneficial effects of smoking cessation on
CVD burden and CVD risk factors.
• Discuss the impacts of cessation on CVD morbidity and
mortality.
Contents
Core Slides:
Optional Slides:
1. Cessation in CVD:
Clinical Management (1)
2. Cessation in CVD:
Clinical Management (2)
3. Cessation in CVD
Patients
4. Cessation Reduces CVD
Morbidity and Mortality
5. Benefits of Cessation for
Reducing CVD Risk
Factors
1. Cessation Medication
for CVD Patients
2. Benefits of Quitting
and CVD Mortality
3. Cessation and CVD
Prevention
CORE SLIDES
Smoking Cessation for CVD Patients
Mini Lecture 3
Module: Effects of Tobacco on the
Cardiovascular System
Cessation in CVD: Clinical
Management (1)
Tobacco cessation counseling should be integrated in the
treatment of patients with CVD, because:
• Smoking directly accelerates atherogenesis, causes
acute cardiovascular events, and is a substantial
contributor to morbidity and mortality in patients with
CVD.1,2
• Smoking contributes to or acts synergistically with other
risk factors such as hyperlipidemia and diabetes.3,4
1. Graham et al. 2007; 2. Benowitz 2003; 3. Mohiuddin et al. 2007; 4. Wilson et al. 2000
Cessation in CVD: Clinical
Management (2)
Tobacco cessation counseling should be integrated into the
treatment of patients with CVD because:
• Smoking cessation reduces morbidity and mortality in
CVD patients.
• The mortality benefit of tobacco cessation in patients
with left ventricular dysfunction is equal to or greater
than the benefit of therapy with angiotensin
converting enzyme inhibitors, beta blockers, or
spironolactone.4
1. Graham et al. 2007; 2. Benowitz 2003; 3. Mohiuddin et al. 2007;
4. Wilson et al. 2000; 5. Teo et al. 2006
Cessation in CVD Patients
• CVD hospitalization is a strong motivator for quitting. The
12 month quitting rate was higher in smokers admitted to
coronary care unit than among smokers in the general
population (25% vs. 3%, respectively).
• Predictors for quitting: light smokers and newly
diagnosed CVD patients.
• Patients were more likely to successfully quit with
intensive cessation intervention and sufficient follow-up
post-hospitalization.
Tonstad and Johnston 2006
Cessation Reduces CVD
Morbidity and Mortality
• Data from the Asia-Pacific region showed that quitting
smoking reduces the risk of CVD by 29% and stroke by
16%.1
• Physicians should repeat cessation messages in every
clinical outpatient visit, and offer a combination of
cessation counseling and pharmacotherapy, if available.2
1. Asia Pacific Cohort Studies Collaboration 2005; 2. Mohiuddin et al. 2007
Benefits of Cessation for Reducing
CVD Risk Factors
• Following smoking cessation, traditional CVD risk factors
and inflammation markers decline gradually.
• The level of inflammation markers reaches the baseline
level of a non-smoker five years after smoking cessation.
• Most of these factors have dose-dependent trends: the
levels of the factors increase with the number of daily
cigarettes smoked.
• Time-dependent trends are also observed: the levels of
other risk factors decrease gradually over time if the
patient stays quit.
Bakhru and Erlinger 2005
OPTIONAL SLIDES
Smoking Cessation for CVD Patients
Mini Lecture 3
Module: Effects of Tobacco on the
Cardiovascular System
Cessation Medication
for CVD Patients
• Medications include nicotine replacement therapy (NRT)
which includes nicotine chewing gum, patch, nasal
spray, inhaler, and tablets(Champix®), and bupropion.
• Risks of nicotine replacement therapy or bupropion in
CVD patients is minimal.
• Benefit of cessation pharmacotherapy for CVD patients
far outweighs the risk of continued smoking or of the
medications themselves.
• Medications are more effective when used with
cessation counseling.
• Cessation counseling should always be offered, even if
medications are not available or are too expensive.
1. Ford and Zlabek 2005; 2. Tonstad and Johnston 2006
Benefits of Quitting
and CVD Mortality
• Patients who quit will have one half the risk of
cardiovascular disease when compared to patients who
continue to smoke.
• The overall mortality risk and the risk of dying from
cardiovascular diseases among people who quit and
stayed quit were similar to those who never smoked.
• The likelihood of dying from cardiovascular diseases was
three to four times higher in people who continued to
smoke compared to those who never smoked.
Bjartveit and Tverdal 2009
Cessation and CVD Prevention
• Decline in smoking, serum cholesterol, and blood
pressure explained more than 50% of the decline of
CVD mortality.
• Smoking cessation with the 5A approach has been
integrated in CVD patient management in Europe.
• The 5As are:
• Asking about smoking behavior
• Advising patients to quit
• Assessing patients’ willingness to quit smoking
• Assisting in preparing a quitting plan
• Arranging for a follow-up visit
Graham et al. 2007
The most important health message a doctor
can give to patients is to quit smoking.