The effectiveness of quitting smoking in coronary heart disease
This category includes 4 primary interventions: smoking cessation, control of dyslipidemia (DLP) and blood pressure, as well as prophylactic administration of drugs by individual patients. Each intervention should be seriously discussed with patients with CVD, diabetes, as well as with patients suitable for primary prevention. This discussion should be documented.
a) prevalence. In the US, cigarette consumption in terms of 1 person. grew dramatically in the first half of the twentieth century. By 1945,> 65% of men born in 1911-1920 smoked. The annual per capita consumption of cigarettes in 1963 reached 4,286 (> 200 packs per year), but has since dropped to 1875. The prevalence of smoking among men reached a peak in 1955, when> 50% of men smoked; in women, the peak came 10 years later.
Since then, the prevalence of smoking among Americans has decreased significantly (to 21%). Currently, 23% of men and 18% of women are smokers in the population> 18 years old. The frequency of smoking among older schoolchildren increased from 30% in the mid-1980s. to 36.5% in 1997, moreover at the expense of girls, but now it is gradually decreasing. The frequency of smoking is higher among people with low socioeconomic status and educational qualifications.
b) Associated risk of smoking. Smoking increases the risk of coronary heart disease (CHD). By the middle of the XX century. The first studies that linked smoking to heart disease were published.
A 1964 Surgeon General’s report confirmed this epidemiological link, and in 1983 Surgeon General’s firmly named cigarette smoking as the main preventive cause of cardiovascular diseases (CVD). The 1989 Surgeon General’s report provided accurate data from case-control observational studies and cohort studies, mostly among men. It is established that smoking increases the frequency of CHD by 2 times and by 50% the mortality from CHD, and this risk increases with age and the number of cigarettes smoked. A similar increase in the relative risk of KBS is observed among women.
In the US, cigarette smoking is the leading modifiable cause of deaths (438 thousand deaths annually, of which 35% is cardiovascular death) and losses> 5 million years of life. Worldwide, the frequency of smoking continues to grow, with the most in developing countries; in 2000, deaths from tobacco smoking were more than 1 million compared with 1990.
c) The benefits of stopping smoking. Evidence from large-scale, randomized, risk-reduction trials of smoking cessation is limited, but observational studies have shown a clear benefit of stopping smoking. People who quit smoking reduce the excess risk of coronary events during the first 2 years by 50%, with the greatest benefit observed in the first few months. This period is followed by a gradual decrease, and after 3-5 years the risk among those who smoked earlier approaches the risk of those who have never smoked.