Drop the smoking habit to protect heart health

Even older, longtime smokers who have cardiovascular disease can cut their risk of heart attack or stroke, and potentially add years to their life by kicking the habit.

“Quitting smoking is going to do more for you than anything I can do,” said cardiologist Peter Chiotellis, MD, who practices at Cape Cod Healthcare’s Heart Center and Cape Cod Hospital, both in Hyannis.

A European study presented in early April before the scientific congress of the European Society of Cardiology threw more support behind the positive effects of quitting for longtime smokers. It looked at 989 smokers with an average age of 60 who were still smoking at least six months after having experienced a heart attack and/or cardiac artery bypass surgery or stent placement. They were being treated with medicines to control cholesterol, blood pressure and platelets.

The researchers used a computer model to estimate how long these patients might live without having another heart attack or stroke. The result was similar whether they quit smoking or kept smoking and took three additional medications to lower cholesterol and fight inflammation – about 4.8 years.

“This indicates that smoking cessation is a very important step towards adding healthy years to one’s lifetime,” lead researcher Tinka Van Trier, MD, of Amsterdam University Medical Centre, Netherlands, said in a written statement. “It is important to remember that the analysis did not even account for the other advantages of giving up the habit – for example on respiratory illnesses, cancer and longevity.”

Smoking Promotes Blockages

A heart attack occurs when a portion of this muscular organ doesn’t get enough oxygen because blood flow is blocked. Unless immediately treated, heart muscle can die, causing permanent damage or death. Bypass surgery and stent placement via angioplasty are both methods to restore blood flow to a blocked area.

The buildup of cholesterol-rich plaque in your arteries, called atherosclerosis, typically causes these blockages. If a section of plaque ruptures, platelets form a clot that also can block an artery. If plaque or a clot block one of your neck’s carotid arteries that feed your brain, you’ll suffer an ischemic stroke, which starts killing brain cells within a few minutes, and could leave you partially paralyzed, confused and reduce your ability to speak and understand others.

Smoking promotes the formation of arterial plaque throughout your body, and quitting can stop or slow the accumulation of plaque, Dr. Chiotellis said.

“Quitting smoking one to two years after a heart attack can cut your risk of another heart attack or stroke by up to 40 to 50 percent,” he said.

Dr. Chiotellis cautioned against interpreting the study’s results as saying quitting smoking was equivalent to taking more medicines to fight plaque and clots.

“In my opinion, smoking negates the benefits of a lot of those medications,” he said.

The additional medications cited in the European study – PCSK9 inhibitors and bempedoic acid to lower LDL cholesterol and colchicine to fight inflammation – aren’t part of routine first-line cardiovascular care in the United States, Dr. Chiotellis said. According to the National Library of Medicine, colchicine is mainly used as a preventative for gout attacks, PCSK9 inhibitors aid your liver in removing LDL or “bad” cholesterol, and bempedoic acid blocks your liver from making cholesterol and is given as a supplement to statins, the standard class of drugs prescribed to lower cholesterol blood levels. Dr. Chiotellis said cardiologists do use colchicine to treat pericarditis, inflammation of the sac surrounding the heart.

Most of his older patients who smoke will quit once they have a heart attack, Dr. Chiotellis said, but some cling to the habit.

“It’s so hard to change,” he said. “The majority of patients we see with cardiovascular disease, especially the older population, are smokers or (their disease is) smoking-related.”

“My recommendation would be not to use medications to keep smoking,” Dr. Chiotellis said. “It’s a false sense of security – it (cardiovascular disease) will get worse and we see it all the time.”

Smoking poses an even higher risk to diabetics, as high blood sugar levels can injure blood vessels and nerves that regulate your heart, according to the Centers for Disease Control and Prevention. Diabetes, as does smoking, promotes plaque formation.

“People with diabetes have accelerated atherosclerosis,” Dr. Chiotellis said, adding that people with diabetes who smoke are the hardest population to treat and may end up with multiple blockages.

The European study shows “the benefits of smoking cessation are even greater than we realized,” according to Dr. Van Trier.

“Smoking cessation remains a cornerstone of preventing heart attacks and strokes and improving overall health at any time, including after a heart attack and at any age,” she wrote. “We know that cigarette smoking is responsible for 50 percent of all avoidable deaths in smokers, of which half are due to cardiovascular disease.”

Dr. Chiotellis agreed, saying “smoking causes whole systemic damage to your body,” and “there’s only so much meds can do. It’s never too late to quit smoking.”