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Euroaction preventive cardiology programme plus intensive smoking cessation with Varenicline

Success with a nurse-led family centred preventive cardiology programme to help high CVD risk smokers to quit and manage their total cardiovascular risk: EUROACTION plus varenicline

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A new study conducted in general practice in Italy, Spain, the Netherlands and the United Kingdom and designed to build on the original EUROACTION demonstration project in preventive cardiology, has shown success in smoking cessation for dependent high CVD risk smokers at the same time as improving total cardiovascular risk. The results for the EUROACTION  plus varenicline trial, coordinated by Professor David Wood’s group at Imperial College London, were presented at the ESC Congress in Paris in September 2011.

Risk Factors and Prevention

Quit smokingA total of 696 smokers, 137 with vascular disease and 559 at high risk of developing CVD, were randomised, 350 to the intervention arm (EA+), and 346 to usual care (UC). 113 partners were also recruited.

At 16 weeks, for the primary endpoint (smoking abstinence for the last seven days confirmed with breath carbon monoxide less than 10 parts per million), 51% of patients in EA+ were abstinent compared to 19% in UC. The odds of being abstinent in the EA+ programme were 4.52 (95% CI 3.20 to 6.39, p<0.0001) compared to usual care.

Dietary and physical activity habits were also improved with 52% of patients in EA+ achieving a Mediterranean diet score 9, compared to 37% in UC (p<0.001). 16% in EA+ achieved the physical activity target compared to 7% in UC (P=0.002) with a corresponding improvement in fitness as demonstrated by a significantly higher proportion achieving the METSmax target on the Chester Step test: 38% in EA+ compared to 27% in UC (p=0.04).

Blood pressure management was improved in EA+ compared with UC. 33% achieved the tight European target of 130/80 mm Hg in EA+ compared with 25% in UC (p=0,03) despite no differences in the use of antihypertensive drugs.

An average of 1.6 kg of weight gain was seen in EA+ in all patients, probably due to the higher level of smoking cessation in this group, and cholesterol levels were higher in those who gained weight. Encouragingly, in those who gained no weight at all in EA+, 42% had stopped smoking and the comprehensive lifestyle approach, which included tailored dietary and physical activity advice, prevented the usual weight gain seen in those who stop smoking.

Self reported health related quality of life as measured by the Euroqol visual analogue scale (EQ-VAS) was significantly higher in EA+ patients in comparison to UC patients.

The investigators say:
‘The original EUROACTION study in general practice showed no effect on smoking. Now nurses have demonstrated that with the help of effective pharmacotherapy, varenicline, we can achieve real gains in smoking cessation in dependent high CVD risk smokers. As importantly we reduced total cardiovascular risk through lifestyle and risk factor management. Tacking smoking cessation in high risk patients in isolation is not sufficient. A comprehensive approach, as evidenced by the EUROACTION programme, is required to reduce total risk.’