Tobacco Smoking in Patients with Cardiovascular Disease.

Smoking tobacco is a major risk factor for patients with cardiovascular disease (CVD). Quitting smoking rapidly reduces the risk for cardiovascular events. The majority of patients who smoke express a desire to stop, and cost-effective interventions are available. Behavioral (counseling) and pharmacologic (nicotine replacement and non-nicotine medications) treatments double or triple the rate of long-term cessation and should be offered in combination to all patients with CVD who use tobacco. Behavioral therapy can be effectively delivered by a variety of health care providers and means (in person, telephone, mail). For patients with CVD, more intensive and sustained interventions should be encouraged. Nicotine patches have been studied extensively in patients with stable CVD and are safe. Bupropion (a non-nicotine aid) also may be especially useful for patients with CVD. Special consideration is needed for patients with acute coronary syndromes (ie, myocardial infarction and unstable angina). It is important to create a clinical environment that supports treatment of patients with nicotine addiction. Simple changes in office and hospital routines and procedures (establishing routine screening to identify users of tobacco, prompts to encourage intervention, establishing links to more intensive nicotine-dependence treatment programs) can substantially improve the identification, treatment, and outcomes for patients with CVD who use tobacco.