Heart disease patients: take your aspirin, toss your cigarettes

Related articles

Two recent studies offer a strong incentive for patients at risk of a heart attack to quit smoking and keep taking their daily dose of aspirin. An Italian study, led by Dr. Furio Colivicchi of San Filippo Neri Hospital in Rome and just published in the American Journal of Cardiology, found that the resumption of smoking after a heart attack can raise a patient s risk of dying as much as five-fold. And, elsewhere in Europe, researchers publishing in BMJ found that patients with a history of heart disease were 63 percent more likely to suffer a heart attack when they stopped refilling their aspirin prescriptions, compared to those patients who continued taking the prescribed dose.

In the Italian study, Dr. Colivicchi and his colleagues followed nearly 1,300 patients who had been hospitalized for acute coronary syndrome (ACS) and who identified themselves as regular smokers prior to their hospitalization. None of the patients smoked while they were hospitalized and all were instructed to abstain from the habit upon their release. Yet the researchers surveyed the patients at various intervals after they left the hospital and found that over 60 percent of them had resumed smoking by the end of the first year; in fact, about half had resumed smoking within just 20 days of leaving the hospital. Those who had started to smoke within ten days of leaving the hospital were five times more likely to die as those who remained smoke-free. After taking into account a number of patient variables, including age, the researchers found that, by resuming smoking after a heart attack, patients increased their risk of death three-fold and the earlier a patient resumed smoking, the more likely he was to die within a year.

In response, medical experts are recommending that hospitals and insurers work to more effectively incorporate anti-smoking counseling into treatment for heart attack patients. It s amazing that over half the patients resumed smoking within 20 days of leaving the hospital, says ACSH's Dr. Ruth Kava. This fact alone demonstrates the strength of nicotine addiction.

It s too bad the currently approved smoking cessation aids work so poorly, says ACSH's Dr. Gilbert Ross. I foresee a time when clean nicotine delivery systems will be sufficiently studied so as to be available to help such desperately addicted smokers such as those who just had a heart attack quit.

And, as the study published in BMJ suggests, heart attack patients (as well as those with a general history of heart disease) who stick with a regimen of low doses of aspirin can further bolster their chances of staying out of the hospital. In this study, European researchers followed nearly 40,000 people with a history of heart disease, ages 50 to 84, who had just begun taking between 75 and 300 milligrams of aspirin per day. The study spanned eight years and found that those patients who discontinued their daily aspirin use were 63 percent more likely to suffer a non-fatal heart attack within one to six months than were those who adhered to their regimen. The researchers noted an increased risk even when the period during which patients discontinued their dosage was as short as 15 days.