REVIEW ER 'S CONCLUSIONS Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD .
This 36 % risk reduction appears substantial compared with other secondary preventive therapies such as cholesterol lowering which have received greater attention in recent years .
The risk reduction associated with quitting smoking seems consistent regardless of differences between the studies in terms of index cardiac events , age , sex , country , and time period .
BACKGROUND Although the importance of smoking as a risk factor for coronary heart disease is beyond doubt , the speed and magnitude of risk reduction when a smoker with coronary heart disease quits are still subjects of debate .
OBJECTIVES To estimate the magnitude of risk reduction when a patient with CHD stops smoking .
Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients.
OBJECTIVES The purpose of this study was to evaluate the clinical outcome of a large cohort of patients who suffered an acute myocardial infa rct ion with absolutely normal epicardial coronary arteries at the post-myocardial infa rct ion coronary angiogram .  The aetiological and prognostic factors in this population were also analysed . BACKGROUND Few data exist concerning the outcome , and aetiological and prognostic factors , of patients with myocardial infa rct ion and angiographically absolutely normal coronary arteries . METHODS Ninety-one patients ( 34 females/57 males ; mean age 50+/-13 years , range 24 - -78 years ) admitted with an acute myocardial infa rct ion had absolutely normal coronary arteries at the angiogram performed 6.2+/-4 days ( range 1 - -15 days ) after the myocardial infa rct ion , defined by smooth contours and no focal reduction ( NC ) . Of the 91 NC patients , 71 were evaluated prospect ively , alongside a systematic search of all aetiological factors reported in the literature . The NC patients were matched for age , sex , and the same period of myocardial infa rct ion onset with a group of 91 patients with coronary artery stenosis ( > 50 % diameter stenosis ) at the angiogram performed 7.3+/-4 days ( range 1 - -15 days ) after the myocardial infa rct ion ( SC ) . RESULTS The percent of smokers was similar between the two groups ; higher prevalence rates of coronary heart disease family history , obesity , hypertension , hypercholesterolaemia and diabetes mellitus were found in SC ( P=0.043 to 0.0001 ) . In NC , coronary spasm was found in 15.5 % , congenital coagulation disorders in 12.8 % , collagen tissue disorders in 2.2 % , embolization in 2.2 % , and oral contraceptive use in 1.1 % . Left ventricular ejection fraction at hospital discharge was higher in NC ( 60%+/-13 % ) than in SC ( 55%+/-13 % , P=0.04 ) . The mean follow-up was 35 months ( range 1 - -100 months ) . Kaplan-Meier event-free survival , with the combined end-point defined as death , reinfa rct ion , heart failure and stroke was 75 % in NC vs 50 % in SC ( P<0.0001 ) . Survival rate was 94.5 % in NC compared to 92 % in SC ( ns ) . Univariate predictors of events in NC were left ventricular ejection fraction ( P=0.03 ) , age ( P=0.02 ) , diabetes ( P=0.01 ) , and smoking ( P=0.03 ) . Using Cox multivariate analysis , independent predictors of long-term outcome in NC patients were left ventricular ejection fraction ( P=0.003 ) and diabetes ( P=0.004 ) . CONCLUSION Aetiological factors , predominantly coronary spasm and inherited coagulation disorder , can be detected in only one third of the patients with myocardial infa rct ion and absolutely normal coronary angiograms despite a systematic search in a prospect i ve population . Mortality rates are similar but morbidity is lower in myocardial infa rct ion patients with absolutely normal coronary angiography compared with those with coronary artery stenosis . The only two independent factors predictive of poor outcome in myocardial infa rct ion patients with normal coronary arteries are left ventricular function and diabetes
REVIEW ER 'S CONCLUSIONS Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD .
This 36 % risk reduction appears substantial compared with other secondary preventive therapies such as cholesterol lowering which have received greater attention in recent years .
The risk reduction associated with quitting smoking seems consistent regardless of differences between the studies in terms of index cardiac events , age , sex , country , and time period .
BACKGROUND Although the importance of smoking as a risk factor for coronary heart disease is beyond doubt , the speed and magnitude of risk reduction when a smoker with coronary heart disease quits are still subjects of debate .
OBJECTIVES To estimate the magnitude of risk reduction when a patient with CHD stops smoking .