Patients who stopped smoking after their heart attack had less chest pain and experienced better mental health than did those who continued to smoke at 1 year after their acute myocardial infarction (AMI).
Moreover, the post-MI quitters had levels of angina and mental health similar to those who had never smoked, and scores improved with the passage of time after smoking cessation, according to a prospective, multicenter study.
Smoking cessation after a heart attack reduces mortality and the risk of recurrent MI by up to 50%, according to Donna Buchanan, Ph.D., and her coinvestigators. However, few high-quality studies to date have examined the effect of smoking cessation on overall health-related quality of life (HRQOL), she said.
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For this study, Dr. Buchanan and her colleagues used data from two large multicenter AMI registries to address how smoking status after AMI is related to mental and physical health status. Using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form 12-item questionnaire, investigators tracked changes in chest pain and mental and physical health status at 1, 6, and 12 months post AMI according to smoking status.
The final cohort included 4,003 patients who were then grouped by smoking status.
Patients were grouped into never smokers (1,145), former smokers (1,374), and current smokers. A total of 1,484 patients were smokers at baseline; of those, 801 were still smoking at 1 year post-MI. The remaining 683 patients quit within the year after their AMI and were classified as recent quitters. In unadjusted analysis, never smokers had the highest health status scores and current smokers the worst, with a gradation across the four categories of smoking status that was statistically significant for all domains, said Dr. Buchanan of the University of Missouri–Kansas City.
Further statistical exploration with multivariable analysis showed that former smokers and never smokers looked similar in all HRQOL, while there was more variability across HRQOL domains for recent quitters. Recent quitters were significantly more likely to report good mental health status than current smokers, even when levels of depression and social support were taken into consideration (Circ Cardiovasc Qual Outcomes. 2015 Aug 25; doi: 10.1161/circoutcomes.114.001545).
In examining physical symptoms, recent quitters had levels of angina similar to those who had never smoked, while persistent smokers had more angina post-AMI than any other group. Dr. Buchanan and her colleagues noted that the oxidative stress, endothelial damage, and proinflammatory state that are caused by smoking all may contribute to ongoing angina. Smokers also experience increased adrenergic tone, and may have more coronary vasospasm.
The study elucidates an important aspect of care for the patient who has experienced a heart attack, said Dr. Buchanan. “Current educational efforts tend to focus on how continued smoking increases the risk of recurrent heart attack and death, but health-related quality of life is often equally or more important to patients than longevity,” she said in a statement. Her hope, she wrote, is that “These observations may help encourage patients to stop smoking after AMI.”
The study was funded by CV Therapeutics and the National Institutes of Health. A coinvestigator owns the copyright to the Seattle Angina Questionnaire, used to assess angina in the study.
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