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STOPPING SMOKING AND FATAL HEART ATTACKS - THE BENEFIT SEEMS TO BE IMMEDIATE
(October 2004)

Smoking cigarettes is a major risk factor for coronary heart disease and heart attacks. The dangers are dose related; smoking less than one-half pack a day carries a small risk; smoking more than one-half pack a day incurs a greater risk, and that is magnified for those smoking one pack a day or more. The increased risk from smoking is not lessened by smoking low tar, low nicotine brands. A big controversy relates to how quickly the risk for heart disease and heart attacks disappears after quitting. Some say it can take ten years or longer; some use the figure five years; others argue the evidence suggests that most of the increased risk disappears within a two-year period after quitting.

A study in the Archives of Internal Medicine in October 2003 adds some useful information on rapidity of benefit upon quitting. They followed 3,122 persons who had a previous heart attack or had persistent heart pain (angina). During the eight-year followup period, 8.1 percent of current smokers died suddenly from a heart attack compared to 4.6 percent of non-smokers. Ex-smokers had exactly the same percentage of sudden deaths as the non-smokers. It did not matter for how long they had stopped smoking. The benefit was found in those who had stopped smoking for less than one year, so the benefit was almost immediate. When they examined all types of heart deaths, 14.1 percent of current smokers died during the followup period, as did 8 percent of ex-smokers and 8 percent of non-smokers.

Commentary: This is a very useful study. It supports strongly the concept that most of the benefit to the heart from stopping smoking occurs very quickly after quitting. Healthful Life has argued that the evidence supports the statement that most of the increased risk of heart attack from smoking disappears within two years of quitting. Here it was even faster. It would have been nice if the investigators had also analyzed number of cigarettes per day in both current and past smokers. That would have provided more precise estimates of risk for smokers and might have provided additional useful information regarding ex-smokers.



because the literature is still inconsistent about how quickly the excess risk of heart attack for smokers disappears. Healthful Life believes that the most likely scenario is that, for most ex-smokers, the risk disappears quickly (within two years), but for a small minority, it takes longer (up to five years), and for an even smaller minority, it may take more than five years. It would make sense that those requiring longer time for the risk to disappear may have smoked more heavily for longer periods of time, but that has not been proved.

In any case, this is good news for ex-smokers and should motivate smokers to quit and health professionals to try even harder to get smokers to stop.

Goldenberg, I., et al. Current smoking, smoking cessation and the risk of sudden cardiac death in patients with coronary artery disease. Archives of Internal Medicine. Vol 163 (October 27) Pgs 2301-2305. 2003.

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