Smoke Signals

The cardiovascular risks of smoking have long been known. It has now been a half a century since the first US Surgeon General reported that smokers had significantly higher risks of coronary heart disease than nonsmokers.1 The cardiovascular benefits of smoking cessation have also been clear for some time. Forty years ago, Wilhelmsson et al2,3 first reported that smokers who continued to smoke after myocardial infarction (MI) had twice the mortality risk as those who quit. Other studies confirmed that smoking cessation after MI was associated with ≈50% reduced risk of vascular death,4 an effect size that dwarfs that seen in other secondary prevention interventions, including aspirin,5 statins,6 or clopidogrel.7 Furthermore, advances in our secondary prevention medication armamentarium have not mitigated the importance of smoking cessation. Even in contemporary practice, those who quit smoking after an MI have significantly lower risks of future mortality and recurrent events relative to those who continue to smoke.8–10 Although these effects on hard cardiovascular end points are impressive, smoking cessation has also been linked to improvements in patient quality of life, functional status, and angina …