Despite Awareness of Cardiovascular Risks, Many Smokers Continue Tobacco Use

An analysis of survey responses from 2013-2018 indicates many patients with a history of cardiovascular disease who use tobacco continue to do so, despite being aware of the increased risk associated with smoking and tobacco use.

Despite the idea that the United States and other nations have won the war on tobacco, a new study suggests a new challenge has arisen in regard to curbing the impact of smoking and tobacco use in patients with a history of cardiovascular disease.

An analysis of survey responses from 2013-2018 among patients within the Population Assessment of Tobacco and Health Study (PATH), results of the study indicate nearly 30% of those with self-reported cardiovascular reported currently smoking or using tobacco products and only 10% reported being actively enrolled in a cessation program.

“The findings of this new study are disturbing, although perhaps not surprising. These results indicate that critical public policies and interventions are needed to address this preventable, leading cause of death and disability not just in the U.S. but around the world,” said Rose Marie Robertson, MD, FAHA, Deputy Chief Science and Medical Officer of the American Heart Association, who was not involved with this study but serves as the co-director of the Association's Tobacco Center of Regulatory Science, which provided support for the study, in a statement.

Led by investigators at the Albert Einstein College of Medicine, the current study was designed to compare data from the first and fourth wave of PATH, which occurred in 2013-2014 and 2016-2018. Using response data from these patients, investigators hoped to describe the prevalence of tobacco use, type of tobacco product used, and patient knowledge about the associations between smoking or tobacco use and cardiovascular disease risk.

Overall, 32,172 survey participants were identified for inclusion. Of these, 2615 had self-reported cardiovascular disease. Among these patients, 24.5% reported having had a heart attack, 22.6% reported having had a stroke, 19.1% reported heart failure, and 60.5% reported having some other heart condition.

Baseline analyses indicated 95.9% of patients with prevalent cardiovascular disease reported knowing or believe smoking could cause cardiovascular disease in smokers. Furthermore, those reporting knowing or believing smoking causes cardiovascular disease were 50-70% less likely to report use of any tobacco product.

Among 2615 participants with self-reported cardiovascular disease at wave 1, 28.9% reported current tobacco use. Among current tobacco users, the most commonly used products were cigarettes (82.8%, any type of cigar (23.7%), and e-cigarettes (23.5%). Further analysis suggested e-cigarette use without concurrent cigarette use was rare among this group of patients (1.1%).

Compared to those with cardiovascular disease at baseline who did not report tobacco use, those reporting tobacco use were more likely to be of a younger age, male sex, have lower education level, and lack of knowledge about the association between smoking and cardiovascular disease. Investigators also noted men with cardiovascular disease were less likely than their female counterparts to use e-cigarettes (OR, 0.7; 95% CI, 0.5-0.9).

Additionally, comparing rates of cigarette use among those with cardiovascular disease between waves 1 and 4 indicated a reduction of less than 5% occurred during that time period. Investigators also pointed out results suggested e-cigarette use increased 0.5% during that same time period and less than 12% were in a formal tobacco cessation program at any point during the study.

“Our findings support the need for a stronger commitment from a multidisciplinary team, including the primary care professional, social worker, psychologist and cardiologist, to provide smoking-cessation therapies and counseling to people with cardiovascular disease,” said lead investigator Cristian Zamora, MD, a third-year internal medicine resident at Jacobi Medical Center at Albert Einstein College of Medicine, in the aforementioned statement.

This study, “Tobacco Use Prevalence and Transitions From 2013 to 2018 Among Adults With a History of Cardiovascular Disease,” was published in the Journal of the American Heart Association.