Abstract
Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.
Highlights
Tobacco use is one of the major causes of death worldwide and the number of patients who die of smoking-related complications is expected to continue rising
There was an equal representation of educational strata and tobacco abuse did not differ among them (p = 0.80)
Residents of urban areas had lesser odds of being tobacco abusers compared to non-urban residents (OR = 0.49, 95% confidence intervals (CI) 0.27 – 0.89, p = 0.014) (Table 1)
Summary
Tobacco use is one of the major causes of death worldwide and the number of patients who die of smoking-related complications is expected to continue rising. Asia-Pacific region shared 65% of global cigarette sales by volume in 2018 making it the biggest cigarette consuming market worldwide.[1] In addition to cigarettes, there are several unique modes of tobacco consumption in South-Asian countries, including pipe smoking, water-pipes and various chewable tobacco formulations.[2] In Pakistan, twenty-three percent of men and five percent of women use any type of tobacco; cigarette smoking being the most common form (22% of men and 3% of women).[3] A study conducted on non-atherosclerotic Pakistani patients showed higher lifetime risk of cardiovascular diseases (CVD) in males (49.4%) compared to females (31.9%).[4] a linear relationship has been observed between number of cigarettes smoked and risk of developing CVD in studies conducted in Pakistan.[5]
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