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Smoking cessation: populations and patients

The morning session on smoking cessation gathered quite a large audience. The lecturers presented new evidence-based arguments that might be very useful for health professionals in their talks with decision-makers and politicians.

Professor E. Froelicher from San Francisco cited that there are 1.3 billion smokers worldwide and a 100 million deaths. The tobacco industry in US has still increased the nicotine yield in cigarettes, which is fundamental to industry success. The trends in cigarette smoking among US physicians and nurses showed a large decline. If the 2.2 million working nurses in the US each helped one person per year to quit smoking, they would triple the US quit rate.

Dr Jan Heidrich from Muenster discussed the impact of smoking bans on the incidence of acute myocardial infarction. Most studies consistently report a decrease in hospitalization rates for AMI. However, the range of reduction (1-20%) in some studies is likely to over-estimate short term effects. Smaller effect (2-8%) might be more plausible.

S. Tonsted from Oslo discussed nicotine effects in the brain and reminded us that if somebody smokes 20 cigarettes per day, there are 240 brain “hits” per day, nearly 100,000 “hits” a year, and a million doses in 10 years. Any success, even if short term, increases long term chances of quitting and this is more likely to be achieved with medication. She stated that nicotine replacement, bupropion and varenicline are safe in patients with CVD, and that bupropion and varenicline have proven 1 year efficacy.

In the last lecture, C. Jennings from London who coordinated EUROSPIRE III survey concluded that older patients > 60 years, patients with a higher level of education, post MI and under cardiologist therapy are more likely to quit.


In summary, in Europe, smoking cessation support for vascular and high risk patients is inadequate. Populations at risk but without vascular disease present a particularly big challenge. Smokers with a high total CVD risk require a total management approach, addressing both lifestyle and risk factors.




Smoking cessation: populations and patients
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.