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European Heart Journal 2004 25(23):2101-2108; doi:10.1016/j.ehj.2004.08.017
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Short-term benefit of smoking cessation in patients with coronary heart disease: estimates based on self-reported smoking data and serum cotinine measurements

Dorothee Twardellaa,*, Jutta Küpper-Nybelena, Dietrich Rothenbachera, Harry Hahmannb, Bernd Wüstenc and Hermann Brennera

a Department of Epidemiology, German Centre for Research on Ageing, Bergheimer Str. 20, D-69115 Heidelberg, Germany
b Klinik Schwabenland, Isny-Neutrauchburg, Germany
c Klinik am Südpark, Bad Nauheim, Germany

Received April 21, 2004; revised August 12, 2004; accepted August 19, 2004 * Corresponding author. Tel.: +49 6221 54 8150; fax: +49 6221 54 8142 (E-mail: twardella{at}dzfa.uni-heidelberg.de).

AIMS: To assess the short-term impact of smoking and smoking cessation measured by self-report and by serum cotinine on the risk of secondary cardiovascular disease events (CVD events).

METHODS AND RESULTS: Cohort study among participants of an in-patient 3-week rehabilitation programme following an acute coronary syndrome or coronary artery revascularization. Smoking status at baseline was assessed by self-report (beginning of the rehabilitation programme, rehab) and serum cotinine (end of rehab). Active follow-up was conducted one year later.

Subsequent CVD events were observed in 139 of the 967 patients. Both self-reported smoking status (odds ratio (OR) compared to continued smokers: recent quitters 0.96, former smokers 0.83, never smokers 0.54, p for trend 0.04) and serum cotinine (OR 0.59 (95% confidence interval (CI) 0.36–0.97) for cotinine-negative compared to cotinine-positive subjects) were associated with the occurrence of a secondary CVD event. After reclassification of all cotinine-positive subjects to continued smokers and cotinine-negative self-reported smokers to recent quitters, this association became even stronger. The OR now reached 0.71 (95% CI interval 0.38–1.33) for recent quitters, 0.64 (0.36–1.11) for former smokers and 0.44 (0.24–0.81) for never smokers (p-value for trend=0.009).

CONCLUSION: The benefits of non-smoking and smoking cessation in cardiac patients are beyond controversy and might even be larger than suggested by previous studies which exclusively relied on self-reported smoking status.


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