| Summary: | Background
Smoking has long been positively associated with the development and progression of coronary heart
disease. However, longitudinal cohort studies evaluating smoking habits among cardiac patients as well as the role of
socio-demographic factors determining such behaviours are scarce and have been focused on primary care practice.
Thus the aim of the present work was to examine the association of active smoking and behaviours and exposure to
second-hand smoke, with the 10-year Acute Coronary Syndrome (ACS) prognosis, among cardiovascular patients.
Methods
From October 2003 to September 2004, a sample of six Greek hospitals was selected and almost
allconsecutive 2172 ACS patients were enrolled. In 2013–14, the 10-year follow-up was performed in 1918
participants (11 % loss to follow-up). Smoking habits at the time of entry to the study, as well as during the
follow-up period were studied using a standard questionnaire.
Results
Patients who had >60 pack-years of smoking had 57.8 % higher ACS mortality and 24.6 % higher risk for any
ACS event. Nested model, adjusted only for age and sex, revealed that for every 30 pack-years of smoking increase, the
associated ACS risk increased by 13 % (95 % CI 1.03, 1.30, p = 0.001). When further adjusted analysis, including several
potential confounders, was applied the tested relationship was still significant (95 %CI 1.03, 1.30, p = 0.09). Accordingly, the
risk for fatal ACS events increased by 8 % for every 30 pack-years of smoking increase (95 % CI 1.03, 1.63, p = 0.06).
Moreover, 52 % of the patients reported being exposed to secondhand smoke and when further adjustments were
made, it was revealed that they had 33 % (95 % CI 1.12, 1.60, p = 0.01) higher risk of having recurrent ACS events.
Conclusions
Active smoking and second-hand smoke among cardiac patients still represent a substantial clinical
burden. Thus, smoking cessation policies should be incorporated into the long-term therapeutic management.
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