Despite Knowing the Risks, Many Adults with CVD Report Current Tobacco Use

Although over 90% of adults with a history of CVD reported knowing that smoking can cause heart disease, nearly 30% reported current tobacco use in a new study.

Many adults with a history of cardiovascular disease (CVD) continue to use cigarettes and/or other tobacco products, despite knowing it increases the risk for subsequent cardiovascular events, according to a new study published in the Journal of the American Heart Association.

The study analyzed survey responses from the national Population Assessment of Tobacco and Health (PATH) study conducted between 2013-2018. The results showed that approximately 30% of those with self-reported CVD reported current tobacco use, yet only about 10% took part in a formal smoking cessation program.

“The findings of this new study are disturbing, although perhaps not surprising. These results indicate that critical public policies and interventions are needed to address this preventable, leading cause of death and disability not just in the U.S. but around the world,” Rose Marie Robertson, MD, deputy chief science and medical officer of the American Heart Association (AHA), said in an AHA press release. Robertson was not involved with the current study, but she serves as the co-director of the AHA’s Tobacco Center of Regulatory Science, which provided support for the study.

To gain further insight into the prevalence of tobacco product use and tobacco product transitions in adults with CVD, researchers compared data from the first (2013-2014) and fourth wave (2016-2018) of the PATH study.

Of the 32 172 survey participants aged ≥18 years, 2615 had a self-reported history of heart attack, heart failure, stroke, or other heart condition, and therefore, were included in the current study.

As previously stated, 28.9% of participants with CVD reported current tobacco use during the first wave (2013-2014). However, by the fourth wave (2016-2018), less than one-quarter of participants with CVD had quit using tobacco.

Also, participation in a formal smoking cessation program decreased from 10% of participants during the second wave (2014-2015) to approximately 2% by the end of the study.

“At the conclusion of our study, we were surprised that so few cigarette users with cardiovascular disease were part of a formal smoking-cessation program,” co-lead author Cristian Zamora, MD, internal medicine resident, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, said in the press release. “It was also concerning that despite the well-documented benefits of stopping tobacco use after a CVD diagnosis, few people had stopped smoking over the course of the five-year study.”

The majority (95.9%) of participants with CVD reported knowing or believing that smoking can cause heart disease in smokers. A significant portion of participants (40.2%) also reported believing e-cigarettes were less harmful than combustible cigarettes.

The most commonly used tobacco product among study participants was cigarettes (82.8%), followed by any type of cigar (23.7) and e-cigarettes (23.3%). Further analysis showed e-cigarette use without concurrent cigarette use was uncommon among participants with CVD (1.1%).

Factors associated with tobacco use were younger age, male sex, lower education level, and lack of knowledge about the association between tobacco use and CVD. Women with a history of CVD were more likely to use e-cigarettes than men.

“Our findings support the need for a stronger commitment from a multidisciplinary team, including the primary care professional, social worker, psychologist and cardiologist, to provide smoking-cessation therapies and counseling to people with cardiovascular disease,” concluded Zamora. “Health care reforms and public health policies should improve the availability of tobacco-cessation programs and tools for high-risk populations.”