Going the distance is worth it
Regarding the role of extended abstinence on subsequent cardiac events, long-term quit status in post-coronary artery bypass graft (CABG) surgery patients has been found to predict decreased morbidity and lower rates of repeat revascularization surgery. Findings from the Coronary Artery Surgery Study show that, at 10-year follow-up, nonsmokers were more likely to be free of angina (54% of nonsmokers vs 42% of smokers; P=.02, NNT=8.3) and less likely to experience moderate to severe physical limitations (13% of non-smokers vs 24% of smokers; P=.0004; NNT=9.1). Nonsmokers also had fewer CHD-related admissions than smokers (2.6 vs 3.8; P<.0001).7
Another study found similar results at 20-year follow-up: Patients who had quit smoking underwent fewer repeat CABGs than smokers (RR=1.41; 95% CI, 1.02-1.94).8 The difference between post-CABG survival curves for quitters versus smokers increased from 3% at 5 years (98% vs 95%) to 15% at 15 years (70% vs 55%; P<.0001; NNT=6.7).8
Recommendations
The US Department of Health and Human Services recommends smoking cessation as an integral part of both primary and secondary prevention of CHD. Quitting reduces development of atherosclerosis and lowers the incidence of initial and recurrent myocardial infarction, thrombosis, cardiac arrhythmia, and death from cardiovascular causes.2