Abstract
BackgroundThe adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP).MethodsThis observational study included 1,026 non-smokers (108 exposed and 918 not-exposed to SHS) from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment.ResultsNon-smoking SHS subjects had a lower prevalence of prior revascularization (85% vs 90%), and had an increased prevalence of stroke (13% vs 7%) and prior smoking (72% vs 61%; all p < 0.05) compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course (77% vs 85%, p = 0.020) compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP (angina class decreased ≥ 1 class: 68% vs 79%; p = 0.0082), both higher than that achieved in current smokers (66%). By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers (OR 1.81, 95% confidence intervals 1.16–2.83).ConclusionNon-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP.
Highlights
The adverse effects of tobacco abuse on cardiovascular outcomes are well-known
Using measurements of the serum concentration of cotinine, a biomarker of smoke exposure, in a large prospective population study, Whincup et al recently concluded that the risk of coronary heart disease related to passive smoke exposure has probably been underestimated in earlier reports and might, be very close to the risk reported for active smokers [11]
The study group consisted of 1,026 non-smoking and 363 current smoking patients treated with external counterpulsation (EECP) for refractory angina enrolled in the Second International EECP Patient Registry (IEPR-II)
Summary
The adverse effects of tobacco abuse on cardiovascular outcomes are well-known. the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP). Epidemiological evidence has unequivocally confirmed that active smoking is a risk factor for cardiovascular disease and the leading cause of preventable death [1,2]. The impact of passive smoking on the cardiovascular system was recognized nearly two decades ago, when evidence of the harmful effects of second-hand smoke (SHS) began to emerge [3,4]. Another study suggested that in the United States more than 50,000 deaths annually from ischemic heart disease are associated with SHS [7]. Epidemiological data suggest a non-linear dose-response relationship between the intensity of exposure to SHS and the risk of ischemic heart disease [8,9]. Using measurements of the serum concentration of cotinine, a biomarker of smoke exposure, in a large prospective population study, Whincup et al recently concluded that the risk of coronary heart disease related to passive smoke exposure has probably been underestimated in earlier reports and might, be very close to the risk reported for active smokers [11]
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