Smoking Cessation as Effective as 3 Meds in Secondary CVD Prevention: 5 Event-free Years

Persons with ASCVD who quit smoking could gain 5 more years of life--similar to the outcome of intensive medical treatment while continuing to smoke.

The benefits of smoking cessation for patients with established atherosclerotic cardiovascular disease (ASCVD) are equivalent to combined use of 3 targeted CV agents, according to a study presented at ESC Preventive Cardiology 2022, the annual scientific congress of the European Society of Cardiology (ESC), held virtually April 7 -9, 2022.

More specifically, investigators found that quitting smoking added the same number of CV event-free years to life as the triple pharmacologic intervention did for persistent smokers.

“This analysis focused on smokers who had experienced a heart attack and/or undergone stent implantation or bypass surgery,” said study lead author Tinka J van Trier, MD, a doctoral student at Amsterdam University Medical Centre, in an ESC press statement. “This group is at particularly high risk of having another heart attack or a stroke and stopping smoking is potentially the most effective preventive action.”

Led by van Trier, the research team set out to assess the overall benefit of smoking cessation, a more global result than afforded by risk prediction models that are usually calculated for a limited set of CV outcomes, such as myocardial infarction (MI) or stroke, they wrote in the study abstract. The breadth of the benefit of quitting will be underestimated if non-CV outcomes are disregarded, they said.

The colleagues conducted a meta-analysis using pooled, individual-level risk factor data from 6 large prospective studies examining lifestyle, risk factors, and CVD management: RESPONSE 1 and 2, OPTICARE, EUROASPIRE IV and V and HELIUS.

Studies included participants aged at least 45 years who continued to smoke at least 6 months after acute cardiac syndrome or revascularization (a median 1.2 years after index event). All participants were appropriately treated with standard preventive medications, ie, statins, antihypertensives, antiplatelet therapy. The final cohort numbered 989, was 23% women and had a mean age of 60 years.

Quitting vs intensive treatment

The researchers estimated and then compared the treatment benefits of smoking cessation vs continued smoking plus the use of one or more of 3 targeted treatments: bempedoic acid, colchicine, and PCSK-9 inhibitors. The estimated treatment benefit was expressed as gain in life years without major CV events (MI, stroke).

Van Trier et al found that smoking cessation was associated with a 4.81-year gain in CV event-free years (95% CI, 4.73-4.89) and reported a comparable gain of 4.83 event-free years (95% CI, 4.72-4.93) with continued smoking plus optimal pharmacologic ASCVD treatment.

“This indicates that smoking cessation is a very important step toward adding healthy years to one’s lifetime,” van Trier said in the ESC statement. “It is important to remember that the analysis did not even account for the other advantages of giving up the habit — for example on respiratory illnesses, cancer and longevity.”

Smoking cessation, Van Trier emphasized, remains a cornerstone of CVD prevention, both primary and secondary. She added that cigarette smoking is responsible for 50% of all avoidable deaths in smokers, of which half are due to cardiovascular disease.”

She also encouraged anyone interested in becoming “smokefree” to talk to their health care professional. “…motivation is key to successfully quitting, but beating an addiction becomes easier with medical and psychological assistance.”

Reference: van Trier, et al. Overall benefits of smoking cessation in patients with ASCVD are underestimated. Presented at ESC Preventive Cardiology 2022, held virtually April 7 -9, 2022,