Reduce cardiac risk with tobacco use cessation.

Tobacco use is a strong risk factor for IHD. Smoking cessation is associated with significant reductions in acute cardiac syndromes. Evidence supports the effectiveness of several smoking cessation interventions, including physician recommendation, multidisciplinary clinics, and pharmacological interventions. However, in general, the better smoking cessation rates have been achieved with combinations of interventions, as compared to a single intervention alone.

Primary care providers should advise every patient who smokes about the potential adverse medical consequences associated with tobacco use and counsel them to quit. Note: Smoking cessation rates of 50% to 75% have been demonstrated in patients who have experienced a major cardiovascular event (Rigotti et al., 1994; Taylor et al., 1990). Detailed recommendations can be found in the VHA/DoD Clinical Practice Guideline To Promote Tobacco Use Cessation in the Primary Care.

Smoking cessation is associated with a significant decline in risk for adverse cardiovascular events. The Framingham study observed a decline in risk of MI with smoking cessation, to nearly that of nonsmokers (Gordon et al., 1974). In the CASS registry, patients with MI who quit smoking had a 50% reduced risk of recurrence, compared with those who continued to smoke (Hermanson et al., 1988). Also, restenosis after percutaneous transluminal angioplasty is decreased with smoking cessation (Galan et al., 1988; Hasdai et al., 1997).