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Quitting smoking post-angioplasty tied to longer life

Students pose for pictures with "big cigarette models" during a campaign ahead of the World No Tobacco Day, at a primary school in Handan, H
Students pose for pictures with "big cigarette models" during a campaign ahead of the World No Tobacco Day, at a primary school in Handan, H

By Veronica Hackethal, MD

NEW YORK (Reuters Health) - People who quit smoking after a balloon angioplasty to improve blood flow to the heart live an average of two years longer than those who keep smoking, a new study suggests.

Researchers found people who were undergoing balloon angioplasty in their 50s, on average, and quit smoking within one year after the procedure lived another 18.5 years. In contrast, those who continued to smoke lived about 16.4 years, on average, after angioplasty.

"Most (smokers) start smoking in their youth and have a smoking history of 40-50 years," said Ron van Domburg, the senior author of the paper and a clinical epidemiologist at Erasmus Medical Center in Rotterdam, The Netherlands.

"Most patients think it is too late to quit smoking, but the major message of our study is that it is never too late to stop smoking," he told Reuters Health in an email.

"Even if you're not willing to stop smoking (for) yourself, do it for your grandchildren. They can enjoy their grandparents for an additional two years."

Previous studies have shown that smoking contributes to an increased risk of heart-related illness and death.

But others reflect just how tough it can be to quit smoking. Relapse rates are high, even with medications and behavioral therapies developed to help people kick the habit.

According to a U.S. Centers for Disease Control and Prevention analysis of 2010 survey data, about 69 percent of smokers want to stop smoking, and about half of these make quit attempts each year. But of those, only about six percent successfully stay off cigarettes.

To determine whether or not quitting smoking is tied to increased life expectancy after heart surgery, van Domburg and his colleagues collected data on 806 patients who underwent balloon angioplasty at Erasmus Medical Center between 1980 and 1985.

During coronary balloon angioplasty, also known as percutaneous coronary intervention (PCI), a balloon-tipped catheter is threaded through blood vessels and the balloon is inflated to clear one or more narrowed vessels.

The researchers asked patients about their smoking habits before and one year after surgery and followed them for up to 30 years. Of the patients, 309 were non-smokers, 210 quit smoking after their surgery and 287 smoked before and after.

Non-smokers and people who had smoked but quit after surgery were equally likely to die during the follow-up period, but death rates were significantly higher among those who continued smoking.

At 30 years post-surgery, 29 percent of quitters were still alive, compared to 14 percent of those who kept smoking, according to findings published in The American Journal of Cardiology. The pattern held after the researchers accounted for health differences between patients at the time of their surgery.

Since the 1980s, new techniques have been developed to treat blocked blood vessels, such as minimally invasive coronary artery bypass grafting (CABG) and using bare metal or drug eluting stents to permanently prop open blocked vessels.

The researchers said it's possible these advances still may not make up for the damage done by smoking on the heart and other organs in the body. But it's hard to know for sure, according to one researcher not involved in the study.

"This group from the early 1980s is very different from patients who currently undergo PCI for angina and (heart attack) so the results may not apply today," Dr. Timothy Crimmins, director of the Vascular Medicine Laboratory at New York Presbyterian/Columbia University Medical Center in New York City, told Reuters Health in an email.

Crimmins noted that the study's importance lies in its long-term follow-up.

"This study is most interesting to me," he said, "Because it actually followed up on a cohort of patients until death, and associated a real increase in life expectancy for patients undergoing PCI who quit smoking."

Crimmins said he planned to use the findings to help encourage his own patients to quit smoking for good.

"Showing patients the deleterious effects of smoking doesn't always inspire them like you think it would," he said. "However, the concrete life expectancy gains this study measured could prove to be motivational."

(The story changes coronary artery bypass grafting to minimally invasive coronary artery bypass grafting in paragraph 14.)

SOURCE: http://bit.ly/1e7pPCt The American Journal of Cardiology, online July 29, 2013.

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