Quitting Smoking After MI Has Huge Benefits in Young Adults

Megan Brooks

July 20, 2020

Young adult smokers who stop smoking in the first year after an initial myocardial infarction (MI) are far less likely to die over the next 10 years than their peers who continue to smoke. Yet nearly two-thirds keep smoking after the event, according to new data from the Partners YOUNG-MI Registry.

"Smoking is one of the most common risk factors for developing an MI at a young age (occurring about 50% of the time). This reinforces the need to have more young individuals avoid, or quit, the use of tobacco," Ron Blankstein, MD, Brigham and Women's Hospital and Harvard Medical School, Boston, told theheart.org | Medscape Cardiology.

Yet, the finding that 62% of young adults continue to smoke 1 year after MI points to an "enormous need for better smoking cessation efforts following a heart attack," he said.

"Powerful" Message for Clinicians

"This study joins an incredibly powerful body of evidence that says if you quit smoking, you're going to live longer," said Michael Fiore, MD, MPH, MBA, director, University of Wisconsin Center for Tobacco Research and Intervention, Madison, who wasn't involved in the study.

"As physicians, there is nothing we can do that will have a greater impact for our patients than quitting smoking. The study is a powerful call for clinicians to intervene with their patients that smoke — both if you have an MI or if you don't," Fiore told theheart.org | Medscape Cardiology.

The study involved 2072 individuals 50 years or younger (median age, 45 years; 81% male) who were hospitalized for an initial MI at two large academic medical centers in Boston. Of these, 33.9% were never smokers, 13.6% were former smokers, and 52.5% were smokers at the time of their MI.

During a median follow-up of 10.2 years, those who quit smoking had a significantly lower rate of death from any cause (unadjusted hazard ratio [HR], 0.35; 95% CI, 0.19 - 0.63; P <.001) and a cardiovascular (CV) cause (HR, 0.29; 95% CI, 0.11 - 0.79; P = .02), relative to those who continued to smoke.

The results remained statistically significant in a propensity-matched analysis for both all-cause (HR, 0.30; 95% CI, 0.16 - 0.56; P < .001) and CV mortality (HR, 0.19; 95% CI, 0.06 - 0.56; P = .003).

"Although patients who quit smoking were similar to those who continued to smoke with respect to their baseline characteristics, smoking cessation was associated with an approximate 70% to 80% reduction in all-cause and CV mortality," the authors note in their article, published online July 8 in JAMA Network Open.

They say it's also noteworthy that long-term death rates of never smokers and former smokers who quit before the MI were nearly identical.

"A Failure of Our Healthcare System"

The bottom line, said Blankstein, is that it is "never too late to quit, and those who experience an MI should do so right way. Our healthcare system must help promote such efforts, as there is immense room for improvement."

Fiore said: "When I see an article like this, it just reminds me that, if you're really thinking about staying healthy, there is nothing better you can do to improve the quality and longevity of your life than quitting smoking."

The observation that many patients continue to smoke after MI is a "failure of our healthcare system and it's an individual failure in that these individuals are not able to overcome their powerful nicotine dependence. It's an unfortunate occurrence that's resulting in unnecessary deaths," said Fiore.

There is no "magic bullet" to overcome nicotine addiction, but there are approved treatments that can "substantially boost quit rates," he noted.

The two most effective smoking-cessation treatments are varenicline (Chantix) and combination nicotine replacement therapy, a patch combined ideally with nicotine mini lozenges, particularly when combined with some brief counseling, said Fiore.

He encourages cardiologists to get their patients to commit to quitting and then link them to resources such as 1-800-QUIT-NOW or SmokeFree.gov.

Funding for the study was provided by grants from the National Heart, Lung, and Blood Institute. Blankstein reported receiving research support from Amgen and Astellas. Fiore has no relevant disclosures.

JAMA Netw Open. Published online July 8, 2020. Full text

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