Many people with cardiovascular disease (CVD) stayed smokers through the last decade, an observational study found, suggesting a need for more smoking cessation therapies and counseling to this population.
In the nationally representative PATH study, 28.9% of U.S. adults with self-reported CVD revealed that they were tobacco users in 2013-2014, which translates to approximately 6.2 million adults in the U.S. with prevalent CVD and current tobacco use at the time, according to Cristian Zamora, MD, of the Jacobi Medical Center at Albert Einstein College of Medicine in New York City, and colleagues.
Cigarette use among people with prevalent CVD was hardly reduced over time (from 22.7% in 2013-2014 to 21.7% in 2016-2018). E-cigarette use also underwent a modest drop at best (from 6.3% to 4.6%), they reported in the Journal of the American Heart Association.
About 10% of cigarette users with CVD were enrolled in cessation counseling. Only 18% of cigarette smokers with CVD in 2013-2014 had quit cigarette smoking by 2016-2018, Zamora’s group found.
The authors suggested that “healthcare reform and public health policies should improve system access and availability of higher intensity of tobacco cessation counseling support for high-risk populations such as those with prior MI, HF [heart failure], or stroke.”
“The intensity of treatment for tobacco dependence matters,” agreed Audrey Darville, PhD, APRN, of the University of Kentucky in Lexington, who cited evidence to support higher-intensity tobacco cessation counseling support for high-risk populations — not just people with CVD, but also those with cancer and other tobacco-related diseases.
Notably, the prevalence of tobacco use in the high-risk CVD population appears to be approximately double that of the general population, Darville observed.
The CV harms of smoking are well established. Indeed, more than 95% of adults with CVD in the study reported knowing or believing that smoking can cause heart disease in smokers.
Even so, individuals with CVD were just as likely as those without CVD to use cigarettes, cigars, e-cigarettes, and dual products.
“People know the harm but continue to smoke. They clearly need more help when trying to quit,” Darville said. “If these statistics regarding treatment applied to any other chronic disease, we would be outraged.”
“We need to stop thinking about tobacco use the way the tobacco industry wants us to think, that using these products is just a choice or a habit. Use of these products has deadly, debilitating, and costly consequences,” she emphasized.
PATH is a cohort study that surveyed adults and teenagers about their tobacco product habits and health. The present analysis followed 32,172 people who participated in 2013-2014 (Wave 1) through 2016-2018 (Wave 4).
Of this cohort, 2,615 people had self-reported CVD, defined as a history of MI, HF, stroke, or another heart condition.
The most commonly used tobacco products were cigarettes (82.8%), cigars (23.7%), and e-cigarettes (23.3%). E-cigarette use without concurrent cigarette use was observed in only 1.1% of smokers with CVD.
“Instead of quitting, many are using electronic cigarettes and smoking. We know there are chemicals in e-cigarettes that are harmful to the heart, so this dual use likely increases the cardiovascular risk overall,” Darville commented.
Factors associated with tobacco use were younger age, male sex, lower education level, and lack of knowledge about the association between smoking and CVD.
Zamora’s group acknowledged the possible misclassification of tobacco use and CVD status in the study.
“This is an important paper and highlights significant concerns regarding the impact of tobacco use on health and why it is critical that we continue to work toward better ways to treat this deadly addiction,” Darville maintained.
The study was supported by grants from the National Heart, Lung, and Blood Institute.
Zamora and Darville had no disclosures.