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 .
Cigarette smoking status and outcome among patients with acute coronary syndromes without persistent ST-segment elevation: effect of inhibition of platelet glycoprotein IIb/IIIa with eptifibatide. The PURSUIT trial investigators.
BACKGROUND Studies have shown that cigarette smokers constitute a substantial proportion of patients with acute coronary syndromes ( ACS ) and have platelet-rich coronary thrombi . We characterized the influence of smoking status on outcome of patients with ACS without persistent ST-segment elevation and tested the hypothesis that selective inhibition of the platelet glycoprotein IIb/IIIa receptor with eptifibatide would improve outcomes among cigarette smokers . METHODS The study population included patients enrolled in the PURSUIT trial ( Platelet Glycoprotein IIb/IIIa in Unstable Angina : Receptor Suppression Using Integrilin Therapy ) with known smoking status presenting with ischemic chest pain < /=24 hours and having either ischemic electrocardiographic changes without persistent ST-segment elevation or elevated creatine kinase MB levels . Patients were r and omly assigned to receive a bolus and infusion of either eptifibatide or placebo in addition to st and ard therapy . The primary end point was a composite of death or nonfatal myocardial infa rct ion within 30 days . RESULTS Of the 9406 patients with known smoking status , 2677 were current smokers , 3086 were former smokers , and 3643 were nonsmokers . Cigarette smokers had better 30-day outcomes ( 12.3 % , 16.8 % , and 15.4 % for smokers , former smokers , and nonsmokers , respectively ; P = .001 ) . However , after adjusting for differences in baseline clinical variables , smoking status was not a predictor of 30-day outcome ( P = .45 ) . There was a reduction in the composite end point overall with eptifibatide compared with placebo ( 14.3 % vs 15 . 7 % , P = .054 ) but no interaction between smoking status and treatment strategy ( P = .68 ) . CONCLUSIONS Among patients with ACS without persistent ST-segment elevation , cigarette smokers had better short-term outcomes because of their more favorable clinical profile . Although prior studies have suggested that smokers more commonly have platelet-rich thrombi than nonsmokers , eptifibatide did not result in more improvement in their outcome compared with former smokers or nonsmokers
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 .