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Smoking Cessation for CVD

Patients
Mini Lecture 3
Module: Tobacco effects on cardiovascular
system

Objectives of the Mini Lectureo


GOAL OF MINI LECTURE: Provide students with
knowledge on the benefits of smoking cessation on
cardiovascular disease burden and its risk factors.
LEARNING OBJECTIVES
Learners will be able to:
Describe the beneficial effects of smoking cessation on
CVD burden and CVD risk factors.
Discuss the impacts of cessation on CVD morbidity and
mortality.

CORE SLIDES

Smoking Cessation for CVD Patients


Mini Lecture 3
Module: Tobacco effects on cardiovascular system

Cessation in CVD clinical


management (1)
Tobacco cessation counseling should be integrated in the
treatment of patients with CVD, because :
Smoking directly accelerate atherogenesis, causes acute
cardiovascular events, and is a substantial contributor to
morbidity and mortality in patients with CVD.
Smoking contributes to or acts synergistically with other
risk factors such as hyperlipidemia and diabetes.

(Graham et al., 2007; Benowitz, 2003; Mohiuddin et al., 2007; Wilson et al., 2000)

Cessation in CVD clinical


management (2)
Tobacco cessation counseling should be integrated in the
treatment of patients with CVD, because :
Smoking cessation reduces morbidity and mortality in
CVD patients.
The mortality benefit of tobacco cessation in patients with
left ventricular dysfunction is equal to or greater than the
benefit of therapy with angiotensin converting enzyme
inhibitors, beta blockers, or spironolactone.

(Graham et al., 2007; Benowitz, 2003; Mohiuddin et al., 2007; Wilson et al., 2000; Teo et al., 2006)

Cessation in CVD patients


CVD hospitalization is a strong motivator for quitting. Twelve
months quitting rate was higher in smokers admitted to
coronary care unit than general population (25% vs. 3%,
respectively)
Predictors for quitting: light smokers and newly diagnosed
CVD
Patients were more likely to successfully quit with intensive
cessation intervention and sufficient follow-up posthospitalization
(Tonstad and Johnston, 2006)

Cessation reduces CVD morbidity


and mortality
Data from Asia Pacific showed that quitting smoking
reduces the risk of CVD by 29% and stroke by 16%.
(Asia Pacific Cohort Studies Collaboration, 2005)

Physician should repeat cessation messages in every


clinical outpatient visit, and offer combination of cessation
counseling and pharmacotherapy, if available.

Benefits of Cessation for reducing


CVD risk factors
Following smoking cessation, traditional CVD risk factors
and inflammation markers decline gradually.
The level of inflammation markers reach the baseline
level of non-smoker five years after smoking cessation.
Most of these factors have dose-dependent trends: the
levels of the factors increase with number of daily
cigarettes smoked.
Time-dependent trends also observed: the levels of other
risk factors decrease gradually over time if the patient
stays quit.
(Bakhru and Erlinger, 2005)

OPTIONAL SLIDES

Smoking Cessation for CVD Patients


Mini Lecture 3
Module: Tobacco effects on cardiovascular system

Nicotine replacement therapy


(NRT)
NRT delivers nicotine without the toxins
from tobacco1
NRT helps combat the symptoms of
withdrawal2
Nicotine dose from NRT is lower and
administered more gradually than with
smoking and this reduces the addictive
potential1,3
1 Benowitz & Gourlay. J Am Coll Cardiol, 1997; 29: 1422-1431.
2 Silagy et al. Cochrane Database Syst Rev, 2004; (3): CD000146.
3 Le Houezec. Int J Tuberc Lung Dis, 2003; 7: 811-819.

The NRT available in Indonesia

Nicotine gum
Nicotine patch

OTC

Nicotine Lozenge
Nicotine nasal spray
Nicotine inhalation

Nicotine sub lingual

NRT Transdermal Patch & Inhaler

NRT Gum & Lozenges

Cessation Medication for CVD


patients
Varenicline (Champix) is one of cessation medication
currently available in Indonesia. The cost for Champix is
35USD (for two weeks treatment) which is almost half
the regional minimum salary in Yogyakarta Province (Rp
700.000}
Other medications include nicotine (chewing-gum,
patch, nasal spray, inhaler and tablet), and bupropion.
Risks of nicotine or bupropion in CVD patients is minimal
Benefit of cessation pharmacotherapy for CVD patients
far outweighs the risk of continued smoking or of the
medications themselves.
(Ford and Zlabek, 2005; Tonstad and Johnston, 2006)

Benefits of Quitting and CVD


mortality
Patients who quit will have one half the risk of
cardiovascular disease that patients who continue to smoke.
The overall mortality risk and the risk of dying from
cardiovascular diseases among people who quit and stayed
quit, were similar to those who never smoked.
The likelihood of dying from cardiovascular diseases were
three to four times higher in people who continued to smoke
compared to those who never smoked.
(Bjartveit and Tverdal, 2009)

Cessation and CVD prevention


Decline in smoking, serum cholesterol, and blood
pressure explained more than 50% of the decline of CVD
mortality.
Smoking cessation with 5A approach have been
integrated in the CVD patient management in Europe.
Ask smoking behavior
Advise patients to quit
Assess willingness to quit smoking
Assist in preparing quitting plan
Arrange for follow-up visit
(Graham et al., 2007)