Supporting smoking cessation in the medical specialist practice 211

Although smoking cessation reduces the cardiovascular risk of smoking, why this is so is still uncertain. Nevertheless, because they are strongly and authoritatively involved in much of the serious health damage caused by smoking, medical specialists should do all they can to support their patients in stopping. This indispensable support can be improved, however, when specialists adapt more motivational and behaviour change promoting attitudes and communicative techniques. Reporting negative evidence can be frustrating. Van den Berkmortel et al., in this issue, were not able to show significant changes over time in intima-media thickness of the femoral and carotid arteries in relation to nonsmoking or smoking cessation. They had to reject the hypothesis that this parameter plays an indicative role in the explanation of the rapid reduction in cardiovascular risk after smoking cessation. Supporting smoking cessation can be frustrating as well. For this study the authors recruited 127 smokers with the intention to stop from the general population. Although they do not report on that, I presume the selection was based on the participants real and strong motivation, and on the provision of some kind of support in their quitting attempts. Nevertheless, only slightly more than a quarter of those 127 remained nicotine-free in the two-year study period. Frustrating perhaps, but such figures are to be expected in supporting smoking cessation and actually not a bad score. Smoking cessation is a serious and difficult endeavour, which is undertaken by many every year, but only with success by a few. Can medical specialists be of help? They should, because smoking is seriously detrimental to health. About 20% of all cancer deaths worldwide are caused by smoking. Smoking causes 80 to 90% of lung cancers with a relative risk in men of over 20 and in women of over 10. Smoking is responsible for most cancers of the bladder, pancreas, oesophagus, and kidneys. Over 80% of chronic obstructive lung disease can be attributed to smoking with a relative risk in both male and female smokers of about 10. The relative risk for cardiovascular disease is about 10 in smokers aged 30 to 50 years, but this risk declines with increasing age as death rates from heart disease also rise in nonsmokers. Across all ages, about 20% of cardiovascular deaths can be attributed to smoking. However, because cardiovascular disease is so common in the population, smoking-attributable deaths from cardiovascular diseases (ischaemic heart disease, claudication, and stroke) outnumber smoking-attributable deaths from all other causes, including lung cancer. Smoking is a cause of peripheral vascular disease, cataracts, and gastric and duodenal ulcers, and contributes to Crohn’s disease. Smoking increases the risk of cerebrovascular disease in a dose-response manner, for both haemorrhagic and ischaemic cerebral infarction, which occurs in conjunction with an increase in atherosclerosis of the carotid arteries. Smoking markedly accelerates atherosclerosis in the abdominal aorta and occlusive disease in its branches. Aortic aneurysm, peripheral vascular disease and renal artery stenosis are increased in smokers. Cigarette smoking is an independent risk factor in the development of atherosclerosis in the internal pudendal and penile arteries of young men with impotence. © 2004 Van Zuiden Communications B.V. All rights reserved. J U L Y A U G U S T 2 0 0 4 , V O L . 6 2 , N O . 7 / 8 211 E D I T O R I A L Supporting smoking cessation in the medical specialist practice