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This chapter discusses the prevention of smoking-related heart disease. Smoking cessation results in an immediate reduction in risk of cardiac events, which continues to decline rapidly. For example, the smoking-related excess risk of myocardial infarction is halved by a year after smoking cessation. The US Public Health Service recommends that all patients be asked about their tobacco use on a regular basis and that those patients who do smoke are advised to quit and are assisted in quitting (see accompanying Hurst’s Central Illustration). Notably, intensive physician advice to quit smoking is associated with a higher rate of smoking cessation than no or minimal advice to quit. Pharmacotherapy and counselling are effective treatments for smoking cessation, particularly when combined. First-line pharmacotherapies include nicotine-replacement therapy (available in the form of patches, gum, lozenges, inhalers, and nasal sprays), varenicline, and bupropion. The efficacy of electronic cigarettes (e-cigarettes) for smoking cessation and their long-term health effects are not well established, and “real world” data indicate that these devices are associated with less quitting than nicotine-replacement therapy or no cessation aids. Tobacco control policies, such as smoke-free workplaces and public places, have had a substantial role in reducing smoking prevalence as well as exposure to secondhand smoke in countries such as the United States and the United Kingdom.

eFig 31-01

Hurst’s Central Illustration: Effective Strategies for Reducing Risks of Cigarette Smoking.

Effective strategies for reducing risks (including cardiovascular risks) of cigarette smoking include addressing smoking cessation in individuals and implementing policies to reduce smoking prevalence and exposure to secondhand smoke. Screening should be incorporated into all outpatient and hospital encounters. Healthcare providers should ask if their patient smokes, advise them to quit, assess their interest in and willingness to quit, assist their patient with counseling and pharmacotherapy, and arrange follow-up appointments to monitor their patient’s progress.


The reductions in cigarette smoking prevalence over the second half of the 20th century and beginning of the 21st century represent one of the major medical and public health advancements of this time. Decreases in smoking rates, in conjunction with improvement in treatment of other cardiovascular risk factors, such high cholesterol and blood pressure, and advancements in the treatment of heart disease, have contributed to substantial declines in rates of death from heart disease.1,2 Despite this progress, tobacco use remains a major preventable cause of morbidity and mortality worldwide. Both active smoking and passive exposure to secondhand smoke increase the risk of cardiovascular disease, malignancy, and pulmonary diseases. As a result, effective strategies for reducing health risks from smoking should address both smoking cessation and reduction of exposure to secondhand smoke.


Smoking cessation is an important component of both primary prevention and secondary prevention of cardiovascular disease. Despite this and the US Public Health Service recommendation ...

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