Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease

Despite declines in smoking prevalence in many Western countries, tobacco use continues to grow in global importance as a leading preventable cause of cardiovascular disease. Tobacco smoke is both prothrombotic and atherogenic, increasing the risks of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease. Even very low doses of exposure increase the risk of acute myocardial infarction. However, smoking cessation and second-hand smoke avoidance swiftly reduce this risk. While promising new agents are emerging, proven cost-effective and safe cessation interventions already exist, such as brief physician advice, counseling and nicotine replacement therapy. These should be routinely offered, where available, to all smokers. This is especially important for those at risk of, or with established and even acute, cardiovascular disease. Clinicians must play a more active role than ever before in supporting complete cessation in patients who smoke and in advocating for stronger tobacco control measures.     

Methods to enhance smoking cessation after myocardial infarction

The evidence linking smoking and coronary artery disease is quite strong, and there is also a positive relationship between smoking cessation and reduction in cardiovascular disease risk. Nicotine replacement therapy and bupropion are effective treatments for smoking cessation and are most effective when combined with behavioral counseling. Intensive multicomponent interventions that include a case-management component have produced the highest smoking cessation rates for patients who suffer a myocardial infarction.     

Review of perinatal partner-focused smoking cessation interventions

One of the primary barriers to smoking cessation among pregnant women who smoke is having a partner who smokes. Prenatal tobacco exposure has been demonstrated to negatively affect infant health outcomes. Many smoking cessation interventions have been targeted at women who smoke in pregnancy, although research has indicated that one of the main barriers to cessation is lack of partner support. The family systems theory frames prenatal smoking cessation interventions in an inclusive manner for the woman and her partner. The aim of this article is to review smoking cessation intervention studies for partners of pregnant women. Efforts to promote smoking cessation among pregnant women should be inclusive of partners, recognizing that partners influence maternal prenatal health behaviors.     

Passive smoking and vascular disease

Passive smoking, or environmental tobacco smoke, is a causative factor in cardiovascular disease. A 30-minute passive smoking exposure was found to affect coronary flow velocity reserve in nonsmokers, indicating endothelial dysfunction in coronary circulation. This article summarizes empirical work on passive smoking and heart disease. Clinically relevant findings include a dose-response relationship between passive smoking exposure and heart disease and partial reversibility of physical effects after eliminating passive smoking exposure. Appropriate assessment of passive smoking exposure in a variety of settings is warranted, as well as recommendations to avoid such exposure. Policy-based public health initiatives to eliminate passive smoking in the workplace and other public areas are needed.     

Cigarette smoking is the most important causal factor for developing chronic obstructive pulmonary disease (COPD)

Cigarette smoking is the most important causal factor for developing chronic obstructive pulmonary disease(COPD). On the other hand, a substantial proportion of COPD cases suffer from obstructive disorder by other causes than smoking, especially among younger persons, females, and residents of developing countries. There are evidences that several rare genetic syndromes(such as alpha 1-antitrypsin deficiency) and occupational exposures as causes of COPD. Environmental tobacco smoke, biomass smoke, and dietary factors are likely causes of COPD, although their contribution is much less compared to active smoking. Smoking during pregnancy may also pose a risk for the fetus, by affecting lung growth and development in uterus. The quicker the smoking cessation is achieved, the more improvements in the lung functions the COPD patients can obtain. Smoking should be avoided as soon as possible in all the COPD subjects and those who are at risk for developing COPD.     

Evidence-based practice to assist women in hospital settings to quit smoking and reduce cardiovascular disease risk

Smoking and obesity are widely recognized cardiovascular risk factors for significant morbidity and mortality in women. Although women still smoke less than men do, smoking among women is on the increase, especially in younger women and teenagers. Reduction of cardiovascular risk through smoking cessation while maintaining weight is a major goal of intervention. The purpose of this article is to discuss best care practices for women with tobacco addiction using a 3-point integration of clinical expertise, the best available evidence gained from systematic research, and an analysis of satisfaction with care data. A model for a smoking cessation intervention with weight management content is presented using a conceptual framework of social learning theory, self-efficacy judgments, and the 4 principal sources of self-efficacy information. The specific aims of this pilot study are to (1) test the feasibility of the study methods and procedures, including subject accrual, attrition, and reliability of the instruments and protocol; (2) explore utilization of and satisfaction with the intervention; and (3) describe the impact of the intervention on primary (smoking biomarker) and secondary (weight/body mass index, depression, partner support, and smoking cessation self-efficacy temptations) outcomes. Results show that the study is feasible, but modifications are needed to improve utilization and satisfaction with care. The primary outcome showed a reduction in the smoking biomarker while maintaining weight at the 2-month follow-up. There was also improvement in skills to manage temptation situations that supported the conceptual framework. Hypotheses are presented for a future experimental study.     

Evidence-based smoking cessation for college students

Despite a strong stance by the American College Health Association and years of prevention and control efforts on US college campuses, smoking and exposure to secondhand smoke remain a problem among college students. This article provides an overview of what is known about cigarette smoking in this population as well as existing interventions for smoking prevention, cessation, and exposure to secondhand smoke on college campuses. Strategies to reduce tobacco use are presented, many of which have been demonstrated to be effective in the short-term.     

The effect of smoking, smoking cessation, and passive smoke exposure on common laboratory values in clinical settings: a review of the evidence

Evidence now supports that active and passive cigarette smoke exposure increase the risk for disease manifestations and adverse outcomes for patients in acute and critical care settings. By understanding the effect of active and passive smoke exposure on common laboratory tests, nurses in acute and critical care settings can plan essential components of care more accurately. This article addresses the effects of active and passive smoking and cessation on common parameters of hematology, hemostasis, immunology and inflammation, and chemistry laboratory tests.     

Serious mental illness and smoking cessation

Persons with serious mental illness (SMI) are faced with substantial challenges to their health. This population is two to three times more likely to smoke cigarettes than persons who do not suffer from mental illness. In particular, young adults are at high risk for vulnerability to both SMI and cigarette smoking. Although there are proven methods for smoking cessation, both pharmacologic and non-pharmacologic interventions show limited usefulness for SMI who smoke. Alternative health care options as well as support groups and physical exercise are discussed as methods that may be useful in smoking cessation. Finally, integration of smoking cessation programming into existing mental health treatment services may offer the greatest opportunity for client success.     

Developing guidelines for smoking cessation interventions for pregnant adolescents.

More than 400,000 deaths a year in the United States are attributed to active and passive tobacco smoke exposure. Healthy People 2000 objectives target a reduction in the tobacco use of high-risk populations such as youth and pregnant women. This article describes guidelines for health professionals to address smoking cessation when working with pregnant adolescents and teen mothers who smoke.     

Alcohol consumption and smoking status: the role of smoking cessation.

Cigarette smoking is common among persons with alcohol dependence or abuse with as many as 80% of persons who are alcohol dependent also being smokers. Not only is smoking common in persons with heavy alcohol consumption, but also nicotine dependence appears more severe in smokers with a history of alcohol dependence. This combined exposure to both tobacco smoke and alcohol results in major health consequences including additive risks for some diseases such as head and neck cancers. Although modest alcohol consumption has some positive health benefits, smoking typically negates these benefits. The cellular mechanisms impacted by combined smoking and alcohol exposure are poorly understood, but molecular epidemiology approaches are providing insights regarding the importance of effects on oxidant/antioxidant pathways and on metabolic pathways involving the cytochrome P450 system. Given the prevalence of smoking in the alcohol dependent population, smoking cessation in this group has the potential for tremendous impact. In recent years, smoking cessation approaches have been initiated in this population, but much work remains in order to define the optimal smoking cessation strategies for persons in alcohol treatment programs.     

Asthma and cessation of smoking

One hundred and twenty-five patients with asthma were questioned on the character of their symptoms in connection with cessation of tobacco smoking. Eighteen out of fifty-nine patients who stopped smoking, reported worsening of their symptoms. The pathogenesis behind this effect may be the effect of tobacco smoke on the immune system particularly macrophages and T cells.     

Cardiovascular effects of second-hand smoke help explain the benefits of smoke-free legislation on heart disease burden

Second-hand smoke (SHS) increases the risk of heart disease by approximately 30% in nonsmokers. Recent evidence from cities that have implemented 100% smoke-free laws has shown that myocardial infarction admissions rapidly declined after law implementation. This decline is, in part, explained by the acute and substantial cardiovascular effects of SHS, many of which are rapid and nearly as large as smoking. The cardiovascular effects of SHS include platelet activation, endothelial dysfunction, inflammation, atherosclerosis development and progression, increased oxidative stress, decreased energy metabolism, and increased insulin resistance. These effects are, on average, 80% to 90% that of chronic active smoking. However, cardiovascular function is partially recovered after SHS exposure ends. Given the evidence, cardiovascular nurses should advise their patients and relatives to avoid SHS exposure and demand smoke-free workplaces and homes.     

不同戒烟时间与正在吸烟AMI患者溶栓再通前后炎症因子表达的差异

目的：探讨不同戒烟时间AMI和正在吸烟AMI患者溶栓再通前、后IL-1、TNF—α和IL-10表达的差异。方法：AMI患者80例,根据患者吸烟状态将患者分为不吸烟AMI组、吸烟〈5年AMI组、戒烟≤5年AMI组和戒烟〉5年AMI组,每组均20例．采用重组链激酶静脉溶栓,分别于溶栓治疗前、溶栓治疗再通后12h和24h采集静脉血,观察IL-1、IL-10和TNF-α的变化。结果：各组IL-1、TNF—Q和IL-10溶栓治疗前后在不同时间点的变化均具有统计学意义（P〈0．01）。吸烟〈5年AMI组和戒烟≤5年AMI组溶栓治疗后,随时间延长,3种炎症因子逐渐升高,但不吸烟组和戒烟〉5年组溶栓后12h和24hIL-1、TNF—α和IL-10的差异无统计学意义（P〉0．05）。溶栓治疗前、溶栓后12h和溶栓后24h,3种炎症因子表达水平吸烟〈5年AMI组和戒烟〉5年AMI组均高于不吸烟组,吸烟〈5年AMI组高于戒烟〉5年AMI组,差异有统计学意义（均P〈0．01）;但不吸烟AMI组和和戒烟〉5年AMI组,吸烟〈5年AMI组和戒烟≤5年AMI组的差异无统计学差异（P〉0．05）。结论：吸烟可上调AMI患者溶栓再通后炎症因子的表达,加重和延长缺血再灌注损伤,损伤时间可达24h,戒烟〉5年可下调3种炎症因子的表达,减轻缺血再灌注损伤。     

Strategies to help adolescents stop smoking

Since most people who smoke begin doing so during adolescence, there is a need for an effective intervention aimed at this age group. This article looks at the factors that increase the probability of smoking and tobacco addiction during adolescence, and concludes with some useful approaches to smoking cessation.     

Health risk behaviors in smoking and non-smoking young women

PURPOSE: To compare the health, health risk behaviors and stress levels of college female smokers and non-smokers. DATA SOURCES: Forty-one college women, ages 18-21 years, participated in an interview and completed a health survey and the Derogatis Stress Profile. CONCLUSIONS: The smokers perceived themselves to be more overweight (Chi square, p = < .001). Smokers used more marijuana (Chi square, p = < .003) and had higher scores on depression [t (39) = 2.29, p = .028], hostility [t (39) = 2.562, p = .014] and perceived quality of health [t (39) = 2.72, p = .01]. In the interview, smokers identified social situations involving alcohol as the time they would most likely smoke. Smokers did not smoke when ill and all were interested in quitting. The non-smoking women support smoking cessation for their peers. IMPLICATIONS FOR PRACTICE: College alcohol and substance use prevention and treatment programs should address tobacco cessation. The majority of college women are not smokers and could be resources to encourage smoking cessation among their peers. Smoking cessation at this age has dramatic implications for future health.     

Evidence-based approach to an inpatient tobacco cessation protocol

Tobacco use contributes to USD53 to USD73 billion per year in healthcare expenditures and causes nearly 440,000 deaths per year. Given the strong cause-effect relationship between smoking and poor health outcomes, it is critical that smokers are identified early and advised about smoking cessation. Furthermore, the Joint Commission now mandates that tobacco cessation advice be given to patients admitted with heart failure, pneumonia, and acute myocardial infarction. As such, an interdisciplinary group at an urban academic medical center developed and implemented a tobacco cessation protocol with the goal of identifying and targeting inpatient smokers through evidence-based education and counseling. The protocol focused on admission assessment, education, and provision of standing orders for medication treatment for nicotine withdrawal and/or tobacco cessation therapy during the inpatient encounter and referral for outpatient counseling at discharge.     

Patient satisfaction and discussion of smoking cessation during clinical visits

OBJECTIVE: To learn whether patients who smoke and who receive smoking cessation information during medical office visits were less likely to be satisfied with the smoking cessation help they received than patients who smoke but who did not receive such information. PATIENTS AND METHODS: A total of 3703 current cigarette smokers were identified by a mailing in November 1998 to 163,596 members of 2 Minnesota health plans, and 2714 (77.3%) responses to a 44-item questionnaire were available for analysis. Using hierarchical analysis to control confounding variables, we assessed the relationship between patient-reported smoking cessation support actions at the last physician visit and satisfaction "with the help received from your doctor about quitting smoking." RESULTS: Smokers were very satisfied (12.0%), satisfied (25.3%), neutral (48.6%), and dissatisfied or very dissatisfied (13.5%) with physician help. After controlling for other characteristics, the 1898 patients who reported that they had been asked about tobacco use or advised to quit during the latest visit had 10 percentage point greater satisfaction ratings and 5 percentage point less dissatisfaction than those not reporting such discussions (P<.001). Smokers reporting no interest in quitting at the time of the latest visit also demonstrated greater satisfaction in association with these actions. CONCLUSION: Smoking cessation interventions during physician visits were associated with increased patient satisfaction with their care among those who smoke. This information should reduce concerns of physicians or nurses about providing tobacco cessation assistance to patients during office visits.     

Links between passive smoking and disease: a best-evidence synthesis. A report of the Working Group on Passive Smoking

We reviewed the toxicologic, clinical, and epidemiologic evidence on the health effects of environmental tobacco smoke (ETS). For each type of exposure to environmental tobacco smoke we have sought articles in the English language reporting studies of effects on human health. Formal criteria that stressed study design, quality of execution and generalizability of results were used to select 116 scientifically admissible reports from over 2,900 articles. We concluded that: (a) there is strong evidence of an association between residential exposure to environmental tobacco smoke and both respiratory illness and reduction of lung function, and also between maternal smoking and reduced birth weight; (b) the weight of evidence is compatible with an association between active maternal smoking during pregnancy and increased infant mortality, and also between residential exposure to environmental tobacco smoke (primarily spousal smoking) and the risk of lung cancer; (c) there is evidence consistent with a relationship between exposure to environmental tobacco smoke in the workplace and respiratory symptoms, (d) the evidence is insufficient to implicate residential exposure to environmental tobacco smoke in relation to other forms of malignant disease or congenital malformations; (e) there is no evidence in the literature of an association between nonresidential exposure to environmental tobacco smoke and any form of cancer. Further studies are required to address the effects of exposure to environmental tobacco smoke, especially nonresidential exposure, in carcinogenesis and as a risk factor for atherosclerosis. Further work is also needed to improve measurement of exposure in such studies and to assess the importance of confounding factors.     

Promoting smoking cessation

Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenicline may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.