“Even in people who smoked and had a heart attack, we see fairly rapid improvements in important measures of health and quality of life when they quit smoking after their heart attacks, compared with people who continue smoking,” said senior author Sharon Cresci, MD, assistant professor of medicine.
The study appears online Aug. 25 in the journal Circulation: Cardiovascular Quality and Outcomes.
Quitting smoking after a heart attack has long been known to reduce risk of a repeat heart attack and risk of death in general. But little was known about other health benefits that might have a more immediate impact on people’s day-to-day lives and provide additional motivation to kick the habit.
The researchers analyzed data from about 4,000 patients participating in several large trials investigating heart attacks and recovery. At the time of their heart attacks, patients were classified as never smokers, former smokers who quit before their heart attacks or active smokers. Of the active smokers, 46 percent quit in the first year following their heart attacks.
“Obviously those patients who had never smoked did the best after their heart attacks,” Cresci said. “But those who had quit prior to their heart attacks looked remarkably similar to the never smokers. The patients who quit after the heart attacks had an intermediate level of recovery but were markedly better than the active smokers, who fared the worst in the amount of chest pain they experienced and in their responses to questionnaires measuring mental health and quality of life.”
The health improvements remained significant even when the researchers controlled for other factors that play a role in measures of mental health and general quality of life, such as pre-existing depression, other medical conditions and socioeconomic factors.
One of the most important indicators of how a patient is doing after a heart attack is the frequency and degree of angina — pain or heaviness in the chest that can radiate into the left arm and neck. It sometimes includes nausea and shortness of breath.
When sustained over a period of time, angina can indicate that a person is having a heart attack. But even intermittent, brief episodes while taking a walk or climbing stairs can be alarming, reducing quality of life and affecting mental health.
“Angina can be quite debilitating for patients,” said Cresci, a cardiologist who treats patients at Barnes-Jewish Hospital. “Episodes of angina are scary, especially when patients have just had a heart attack. The symptoms are a signal that the heart is not getting enough oxygen, which affects the quality of people’s daily lives.”
Cresci emphasized that standard care for smokers who have had heart attacks includes offering support to help them quit smoking. Also an assistant professor of genetics, Cresci is conducting studies looking at genetic factors that might make quitting more difficult for some people. A current study is investigating whether genetics can predict which patients may benefit most from specific types of smoking-cessation strategies, such as nicotine replacement or one-on-one counseling.
This work was supported by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH), grant numbers P50 HL077113 and R01 NR013396; and by CV Therapeutics Inc.
Buchanan DM, Arnold SV, Gosch KL, Jones PG, Longmore LS, Spertus JA, Cresci S. Association of smoking status with angina and health-related quality of life after acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes. Online Aug. 25, 2015.