Coronary heart disease: Epidemiology of smoking and intervention studies of smoking

doi:10.1016/0002-8703(88)90644-8

American Heart Journal

Volume 115, Issue 1, Part 2, January 1988, Pages 242-249

https://doi.org/10.1016/0002-8703(88)90644-8 Get rights and content

Abstract

Smoking is a strong risk factor for myocardial infarction (MI) and sudden coronary death, but not for angina pectoris that is not complicated by a MI. Even light cigarette and pipe and cigar smokers run an increased risk for MI and sudden coronary death. Smoking potentiates other risk factors such as lipid abnormalities and hypertension. Smoking increases blood pressure acutely, but smokers have generally had lower blood pressures than nonsmokers in epidemiologic studies. Smoking adversely affects the prognosis in patients who have suffered a MI and those with angina pectoris. Of great importance regarding community risk of smoking are the many light and moderate smokers. These persons should be addressed more vigorously in intervention efforts.

References (28)

F. Gyntelberg et al.
Smoking and risk of myocardial infarction in Copenhagen men aged 40–59 with special reference to cheroot smoking
Lancet
(1981)
M. Hagman et al.
Risk factors for angina pectoris in a population sample of Swedish men
J Chronic Dis
(1987)
T.W. Meade et al.
Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study
Lancet
(1986)
J.C. Schoenenberger
Smoking change in relation to changes in blood pressure, weight, and cholesterol
Prev Med
(1982)
S. Freestone et al.
Effect of coffee and cigarette smoking on the blood pressure of untreated and diuretic-treated hypertensive patients
Am J Med
(1982)
C. Wilhelmsson et al.
Smoking and myocardial infarction
Lancet
(1975)
D. Sparrow et al.
The influence of cigarette smoking on prognosis after a first myocardial infarction
J Chronic Dis
(1978)
W.B. Kannel et al.
Latest perspective on cigarette smoking and cardiovascular disease: the Framingham Study
J Cardiac Rehabil
(1984)
L. Wilhelmsen et al.
The multifactor primary prevention trial in Göteborg Sweden
Eur Heart J
(1986)
Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling project
J Chronic Dis
(1978)

A. Keys et al.

Coronary heart disease among Minnesota business and professional men followed fifteen years

Circulation

(1963)

R. Doll et al.

Mortality in relation to smoking:20 years'observations of male British doctors

Br Med J

(1976)

E.C. Hammond

Smoking in relation to the death rates of one million men and women

E.W.R. Best

A Canadian study of smoking and health

(1966)

Cited by (157)

Risk factor control, lifestyle intervention, and prescribed medication in a cohort of patients with ischemic heart disease
2024, Semergen
El objetivo de este estudio fue analizar las medidas de prevención recomendadas en nuestra área de salud a los pacientes que se les da el alta tras un infarto de miocardio.
Estudio descriptivo retrospectivo que seleccionó a los pacientes que habían tenido un síndrome coronario agudo (SCA) en nuestra área de salud en un año natural. Se estudió el control de los factores de riesgo que presentaban en el momento del evento coronario y al año, así como la medicación pautada tras un año del episodio. Se analizaron variables como la edad, sexo, control de dislipemia, hipertensión arterial o diabetes mellitus, adherencia a tratamiento y hábitos de vida.
Se observó que el control de los factores de riesgo era insuficiente en el momento del infarto, en ocasiones incluso sin diagnosticar y, aunque se percibió una discreta mejoría, seguía siendo insuficiente al año del mismo. Por otro lado, los pacientes estaban infratratados, especialmente en el caso de las mujeres, con un 20% más de pacientes varones bien tratados al año del infarto que de pacientes mujeres.
Se ha de realizar un esfuerzo adicional respecto al que se realiza en el momento actual, tanto por los especialistas de atención hospitalaria como de atención primaria, para realizar un buen control de los factores de riesgo, entendiendo por ello el control de ciertas enfermedades como la diabetes, la hipertensión arterial o la dislipemia, así como el de los hábitos o estilos de vida que aumentan la probabilidad de padecer un evento cardiovascular. Además, es importante para evitar estas enfermedades cardiovasculares y su recaída reforzar la adherencia a los tratamientos prescritos.
The aim of this study was to analyze the recommended prevention measures in our health area for patients discharged after a myocardial infarction.
This was a retrospective descriptive study that selected patients with acute coronary syndrome in our health area in the previous calendar year. Control of the risk factors observed at the time of the coronary event and at 1 year and medication prescribed 1 year after the episode were studied. Variables including age, sex, control of dyslipidemia, hypertension or diabetes mellitus, adherence to treatment and lifestyle habits were analyzed.
Risk factor control was insufficient and sometimes even unassessed at the time of infarction. Although a slight improvement was perceived, control remained insufficient 1 year later. Moreover, patients, particularly women, were undertreated: one fifth (20%) more men were receiving appropriate treatment than women year after the myocardial event.
An additional effort must be made compared to what is currently being done, both by specialists in Hospital Care and Primary Care, to carry out good control of risk factors, meaning the control of certain diseases such as diabetes, high blood pressure or dyslipidemia, as well as habits or lifestyles that increase the probability of suffering a cardiovascular event. Furthermore, it is important to avoid these cardiovascular diseases and their relapse to reinforce adherence to the prescribed treatments.
Effect of smoking on culprit lesion plaque burden and composition in acute coronary syndrome: An intravascular ultrasound-virtual histology study
2021, Indian Heart Journal
Citation Excerpt :
Impairment of vasomotor function, inflammation and oxidation of lipids are major mechanisms for initiation and progression of atherosclerosis which appear prior to the onset of structural and pathologic manifestations.3–7 Smoking mainly leads to acute coronary events and less for the occurrence of stable angina.8 Further, studies demonstrated a faster reversal in cardiovascular risk following smoking cessation as compared to reduction seen with cholesterol and blood pressure lowering drugs, which predominantly target atherosclerotic process.9–11
Activation of NLRP3 inflammasome assembly is associated with smoking status of patients with coronary artery disease
2020, International Immunopharmacology
Citation Excerpt :
The imperative determinants of atherogenesis embrace the concomitant risk factors such as smoking, hypercholesterolemia, etc. [1]. Smoking is one of the major, modifiable and well-known risk factors that contribute to atherosclerotic progression [1,2]. Smoking is known to induce oxidative stress that may perpetuate a pro-inflammatory response [1].
Cigarette smoke is considered as a sterile inflammatory stimulus which triggers an innate immune response, accountable for vascular events. Previously, we reported smoking-induced NLRP3 inflammasome activation in the pathogenesis of atherosclerosis through caspase-1 activation and secretion of pro-cytokines (interleukin (IL)-1β and IL-18) in vitro and in vivo. Therefore, the present study aimed to reconnoitre the association of cigarette smoking and NLRP3 inflammasome activation ex vivo in human subjects with coronary atherosclerosis.
In order to establish and validate the association between smoking status and NLRP3 inflammasome ex vivo, mononuclear cells were isolated from smokers with angiographically-proven coronary artery disease (CAD); non-smokers with CAD; smokers without CAD, and healthy non-smokers (controls) (n = 20 each). The transcriptional and translational expression of NLRP3 inflammasome markers i.e. NLRP3, pro-caspase-1, caspase-1, pro-IL-1β, IL-1β, pro-IL-18 and IL-18 was significantly increased (2 to 7-fold) in smokers with CAD vs non-smokers with CAD; and smokers without CAD vs non-smoker controls. In addition, the oxidative stress, an upstream mediator of NLRP3 inflammasome was evaluated and found to be significantly augmented in smokers vs non-smokers (with and without CAD respectively). Further, the levels of serum cotinine, oxidative stress markers (8-isoprostane and 8-oxo-2́′-deoxyguanosine), caspase-1 and pro-cytokines (IL-1β and IL-18) were also higher in smokers vs non-smokers. Moreover, the levels of pro-cytokines were positively correlated with caspase-1 and serum cotinine, corroborating the secretion of cytokines in a caspase-1-dependent manner.
Our data may imply NLRP3 inflammasome as a mediator of the pro-atherosclerotic property of cigarette smoking in atherosclerotic patients.
Clinical, Angiographic Characteristics and In-Hospital Outcomes of Smoker and Nonsmoker Patients After Primary Percutaneous Coronary Intervention
2019, Global Heart
Smoking is a well-established cardiac risk factor there is dearth of Local data regarding clinical and angiographic characteristics of smoker patients.
This study was planned to assess the differences in the clinical characteristics, angiographic characteristics, and in-hospital outcomes of smokers and nonsmokers after primary percutaneous coronary intervention at a tertiary care hospital in Karachi, Pakistan.
We included patients between 40 and 80 years of age diagnosed with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention from July 1, 2017, to March 31, 2018. Clinical and angiographic characteristics and in-hospital outcomes were obtained from the cases submitted to the National Cardiovascular Data Registry's CathPCI (Catheterization–Percutaneous Coronary Intervention) Registry from our site.
A total of 3,255 patients were included in this study. Smokers consist of 25.1% (817) of the total sample. A high majority of smokers were male, 98.8% (807), and smokers were relatively younger as compared to nonsmokers with a mean age of 52.89 ± 10.59 versus 55.98 ± 11.24 years; p < 0.001. Smokers had higher post-procedure TIMI (Thrombolysis In Myocardial Infarction) flow grade III: 97.8% (794) versus 95.53% (2,329); p = 0.037, and they had a relatively low mortality rate: 2.69% (22) versus 3.16% (77); p = 0.502.
Smokers were predominantly male and around 3 years younger than nonsmokers. Diabetes mellitus and hypertension were less common among smokers and single-vessel disease was the more common angiographic finding for smokers as compared to 3-vessel disease for nonsmokers. No statistically significant differences in in-hospital outcomes were observed. ST-segment elevation myocardial infarction in smokers despite younger age and the low atherosclerotic risk profile, in our region, emphasize the need for nicotine addiction management and smoking cessation campaigns at large and for pre-discharge counseling.
Tobacco and arteritis
2016, Archives des Maladies du Coeur et des Vaisseaux - Pratique
Association between smoking habits and the first-time appearance of atrial fibrillation in Japanese patients: Evidence from the Shinken Database
2015, Journal of Cardiology
Citation Excerpt :
Tobacco smoking is a well-known risk factor for cardiovascular disease [20,21]. Smoking causes endothelial dysfunction and atherosclerosis [22–25], and also can cause cardiac arrhythmias [26] through the combined effects of nicotine, carbon monoxide, and polycyclic aromatic hydrocarbons. These studies indicate that tobacco smoking may accelerate atrial remodeling, contributing to the development of AF.
We previously reported a cross-sectional analysis regarding the relationship between smoking and atrial fibrillation (AF) in a single hospital-based cohort with Japanese patients, but the effect of cessation of smoking and/or total tobacco consumption were unclear.
We used data from the Shinken Database 2004–2011 (men/women, n = 10,714/6803, respectively), which included all new patients attending the Cardiovascular Institute between June 2004 and March 2012. After excluding those previously diagnosed with AF (n = 2296), 15,221 patients (men/women, n = 9016/6205) were analyzed. During the follow-up period of 2.0 ± 2.1 years (range 0.0–8.1), the incidence rates of new AF in smokers and non-smokers were 9.0 and 5.0 per 1000 patient-years, respectively. In adjusted models with Cox regression analysis, smokers were independently associated with new AF [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.09–2.00]. Also, current smokers (HR 1.81, 95% CI 1.17–2.79) and smokers with Brinkman index ≥800 (HR 1.69, 95% CI 1.05–2.70) were independently associated with new AF. However, in current smokers, the HRs were not different by Brinkman index (Brinkman index <800/≥800; HR 1.81/1.82, 95% CI 1.07–3.05/0.94–3.51, respectively).
Smoking was independently associated with the first-appearance of AF in patients in sinus rhythm, especially when the patients continued their smoking habit. However, in patients who continued smoking, difference by total tobacco consumption was not observed, suggesting the significance of cessation of smoking for preventing AF. Our data are limited because of a single hospital-based nature and a relatively short observation period.

View all citing articles on Scopus

^☆: Supported by grants from The Swedish National Bank Tercentenary Fund, The Swedish Association against Heart and Chest Diseases, and The Knut and Alice Wallenberg Foundation.

View full text

Coronary heart disease: Epidemiology of smoking and intervention studies of smoking☆

Abstract

Lancet

J Chronic Dis

Lancet

Prev Med

Am J Med

Lancet

J Chronic Dis

Latest perspective on cigarette smoking and cardiovascular disease: the Framingham Study

J Cardiac Rehabil

The multifactor primary prevention trial in Göteborg Sweden

Eur Heart J

Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling project

J Chronic Dis

Coronary heart disease among Minnesota business and professional men followed fifteen years

Circulation

Mortality in relation to smoking:20 years'observations of male British doctors

Br Med J

Smoking in relation to the death rates of one million men and women

A Canadian study of smoking and health