Sex-specific disparities in predictive factors of smoking cessation among smokers at high cardiovascular risk. Findings from a nationwide smoking cessation services cohort

Abstract

Abstract Background Tobacco use is a major risk factor for cardiovascular diseases (CVD), but smoking cessation (SC) reduces or even cancels the risk of CVD for both sex. Using data from the French national “Consultations de Dépendance Tabagique” (CDTnet) cohort, we aimed to determine the predictive factors of SC in men and women smokers at high cardiovascular (CV) risk (i.e. with a CV disease or risk factor). Material and methods Retrospective study from the French SC services CDT-net database. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (BMI ≥25 kg/m2, hypercholesterolemia, diabetes, arterial hypertension) or CVD (history of stroke, myocardial infarction or angina pectoris, peripheral arterial disease (PAD)). Smoking abstinence (≥28 consecutive days) was self-reported and confirmed by exhaled carbon monoxide <10 ppm. Logistic regression assessed the association between SC and sociodemographic factors, medical characteristics and patients' smoking profile. Results Among the 246,364 subjects in the database, 15% (36,864) fulfilled the inclusion criteria. One month-abstinence was lower in women (52.6% (n=8,102) vs 55% (n=11,848) in men, p<0.001). For both sex, smokers with the lowest abstinence rates were those with respiratory diseases (47% among women vs. 50% among men respectively), depression history (48% vs. 48%), anxiety or depression symptoms (49% vs 50%) use of anxiolytics/antidepressants, use of opioid substitution treatment, use of cannabis (42% vs 41%) and benefit less than 3 follow-up visits (36% vs 41%). Factors positively associated with SC in both sex were age >65 years, having a degree, being employed, coming by self-initiation or by one's relatives, being overweight, having previous quit attempts, presenting with low nicotine dependence and being confident in achieving abstinence. Factors negatively associated with abstinence only in women but not in men was alcohol disorder. Finally, factors negatively associated with abstinence only in men but not in women were PAD, and tobacco-related cancers. Conclusion Our results from a large nationwide database suggest the relevance of differentiated management according to sex in smokers at high CV risk, given the major sex-specific disparities in factors associated with abstinence rates. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019.