“Healthcare providers should counsel patients about how smoking cessation not only reduces the risk of death and having another heart attack, but also reduces the risk of having chest pain and may likely improve general mental health,” said Donna Buchanan, associate professor at UMKC School of Medicine and the study’s lead author. She is also a psychologist, researcher and manager with Saint Luke’s Mid America Heart Institute’s cardiovascular outcomes research group.
UMKC School of Medicine co-authors include Suzanne Arnold, Philip Jones, Lance Longmore and John Spertus. Findings in the study, published Aug. 25 online in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, support previous research, reinforce the message that smoking has negative effects on health and strengthens the case to provide more education for heart attack patients.
“This information may offer current smokers increased motivation to quit smoking,” Buchanan said.
Researchers assessed 4,003 adults in two U.S. multi-center heart attack patient registries for smoking, chest pain and health-related quality of life measures such as physical and mental components at admission and at one, six and 12 months after their heart attacks.
At admission, patients were identified as those who never smoked (29 percent), former smokers who quit before their heart attacks (34 percent) and active smokers (27 percent). Of the active smokers, 46 percent quite smoking within the first year after their heart attacks.
Researchers found worsening health status with continued smoking:
- Heart attack patients who never smoked had the best health status.
- Those who stopped smoking before a heart attack were similar in health status to those who never smoked.
- Smokers who quit within a year after a heart attack had intermediate levels of health status with chest pain and mental health similar to those who never smoked, and better mental health than persistent smokers.
- Those who continued to smoke after a heart attack had the worst health status of the four groups. At the one-year follow-up, persistent smokers had 1.5-fold higher odds of having chest pain compared to those who never smoked. Their assessment scores were 3.5 points lower for quality of life related to chest pain, 1.6 points lower for general physical functioning and 2.3 points lower for general mental health.
“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,” Buchanan said.
Smoking is one of the most preventable cause of premature death in the United States, according to the American Heart Association. It increases the risk of several disorders including atherosclerosis (the buildup of fatty substances in the arteries), which can lead to heart disease and stroke.
The National Institutes of Health; National Heart, Lung and Blood Institute; and CV Therapeutics Inc. funded the study.
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, published online August 25, 2015; doi: 10.1161/CIRCOUTCOMES.114.001545.