Quitting Smoking After MI Lowers Angina Risk, Ups Well-being

Marlene Busko

August 27, 2015

KANSAS CITY, MO — A year after having an MI, patients who still smoked were more likely to have angina, and they scored worse on mental- and physical-health aspects of quality of life, compared with other patients, in a new study[1].

However, patients who had quit smoking before their MI had a similar health status as patients who never smoked (who had the best health status). And patients who quit smoking after their MI had intermediate levels of chest pain and their mental-health scores were similar to those of nonsmokers.

Thus, having a better quality of life after MI (in addition to the well-known benefit of a lower risk of having a repeat heart attack or dying earlier) might motivate smokers to ditch the habit, say the researchers led by Dr Donna M Buchanan (Saint Luke's Mid America Heart Institute, Kansa City, MO).

These findings "may help address concerns patients have that smoking cessation may not really make a difference in how they feel or could have detrimental effects on their mental health," Buchanan told heartwire from Medscape. Moreover, "improvements in . . . health status . . . could be seen as a 'reward' and be a motivating factor [for smoking cessation]."

The study, based on data from two large multicenter registries—the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) and the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH)—was published August 25, 2015 in Circulation: Cardiovascular Quality and Outcomes.

Quality-of-Life Reasons to Quit Smoking

Patients recovering from MI have little information about the potential effect of smoking cessation on angina and quality of life, since few studies have looked at this, even though living well is often seen as being as or even more important than living long, Buchanan and colleagues write.

They studied the associations between smoking, angina, and health-related quality of life in 4003 patients with acute MI from two large, consecutive US registries: PREMIER, which enrolled patients from 19 US hospitals in 2003 and 2004, and TRIUMPH, which enrolled patients from 24 US hospitals from 2005 through 2008. The patients were assessed at hospital admission and 1, 6, and 12 months later.

Angina and angina-related quality of life were determined from the Seattle Angina Questionnaire—which asks patients, among other things, to report how often they had chest pain in the past 4 weeks and how much this limits their daily activities and enjoyment of life—and from the Short Form-12 Physical Component Summary Score, which asks about limitations in performing moderate physical activities such as moving a table, pushing a vacuum, or climbing several flights of stairs, Buchanan explained.

Mental-health status was determined from the Short Form-12 Mental Component Summary Score, which asks how often patients feel calm/peaceful or energetic or downhearted/depressed and how often their emotional problems limit their work or other daily activities.

Compared with other patients, at hospital admission, smokers tended to be about 10 years younger (54 vs 63), unmarried, less educated, and of lower socioeconomic status and with higher depression scores and fewer comorbidities. They were also more likely to present with STEMI and be treated with PCI but less likely to participate in cardiac rehabilitation.

Patients were placed in four categories of smoking at 1 year after their MI:

  • 1145 patients (29%) never smoked.

  • 1374 patients (34%) were former smokers who had quit before their MI.

  • 683 patients (17%) were recent quitters who quit after their MI.

  • 801 patients (20%) were persistent smokers.

About half of the patients who were smokers at the time of their MI (46%) quit smoking within a year.

One year after their MI, 17% of those who never smoked had angina, compared with 18% of those who quit before their MI, 24% of those who quit after their MI, and 29% of those who continued to smoke (P<0.001), Buchanan said.

Patients who had never smoked were the least likely to report chest pain and had the best health-related quality-of-life scores.

Compared with patients who had never smoked, persistent smokers were 1.5 times more likely to have chest pain 1 year after their MI, after adjustment for demographic, clinical, and treatment factors. They also had lower angina-related, physical, and mental quality-of-life scores.

Patients who had quit smoking within the year after their MI had similar scores related to angina as patients who still smoked, but they had better scores for the SF-12 mental component summary. Further, longer studies would be needed to determine if patients who recently quit smoking see later angina-related benefits, Buchanan and colleagues note.

PREMIER was supported by CV Therapeutics and TRIUMPH was supported by the National Heart, Lung, and Blood Institute. Buchanan reports no relevant financial relationships; disclosures for the coauthors are listed in the article.

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