Journal Club - Smokers With Heart Disease can add up 5 Years by Quitting

Adverse effects of smoking and heart health in smokers. Smoking cessation appears to be comparable to the use of three targeted drugs in warding off future major cardiovascular events in smokers with atherosclerotic cardiovascular disease (ASCVD), according to a new study.

According to data from six large, prospective randomized trials, patients would gain, on average, 4.8 years free of a myocardial infarction (MI) or stroke by quitting smoking or by taking bempedoic acid, colchicine, and a PCSK9 inhibitor.

The overall benefits of smoking cessation in patients with atherosclerotic cardiovascular disease are underestimated, study authors reported. The findings were presented at the recent European Society of Cardiology (ESC) Preventive Cardiology 2022.

New risk-prediction models estimate treatment benefit in years free of specific cardiovascular outcomes, but we feared that, due to the increasing number of beneficial pharmacological interventions available, the substantial health benefit of smoking cessation may be overlooked, and that is what prompted our current study.

The investigators pooled individual-level risk factor data from six recent prospective studies: The analysis involved 989 patients 45 years and older who were treated with antiplatelet agents, statins, and antihypertensive drugs but were still smoking at least 6 months after having an MI and/or undergoing stent implantation or coronary bypass surgery.

The primary outcome was treatment benefit, defined as gain in years without an MI or stroke, as estimated by the SMART-REACH model. Smoking cessation resulted in a mean of 4.81 event-free years a gain comparable with persistent smoking with the three drugs combined. The average number of event-free years was 0.6 with bempedoic acid alone, 2.2 with colchicine alone, and 2.6 with only a PCSK9 inhibitor.

However, it was new to express this benefit in a comparison to the benefits of medication. For example, PCSK9 [inhibition] is known for its efficacy, but it is also very expensive, said researchers, they hoped this information motivates healthcare professionals and patients to quit smoking prior to prescribing expensive drugs. It might not even be needed.