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Heart Health: Smoking cessation



It is estimated that a little more than 18 percent of Hampden County residents are smokers — several points higher than both state and national percentages.

One of my career-long focuses as a preventive cardiologist has been to promote smoking cessation and to study what barriers might prevent my patients from engaging in this behavioral change.

Despite the availability of fancy drugs and high-tech devices which many gravitate to, it turns out that “low tech” behavior changes such as exercise, smoking cessation, and weight loss make a much greater contribution to quality and length of life than the “high-tech” and expensive procedures. My desire to help people make these changes is what drew me into preventive cardiology.

This is because smoking not only puts an individual at risk for several forms of cancer, most notably lung, but is a major cause of heart disease and stroke and a risk factor for type 2 diabetes. And ceasing to smoke is the biggest behavior change patients can make to avoid recurrent hospitalization for heart disease.

Rates of cigarette smoking have declined in recent years in the country, but smoking remains the leading cause of preventable disease, disability, as well as death in the United States. Each year, about 480,000 people die from a smoking-related illness, robbing them of more than 10 years of life.

Many people in America mistakenly believe that, because they don’t see many people smoking in public, that smoking is no longer a public health problem. But this epidemic is far from over.

The Centers for Disease Control and Prevention estimates that about 34 million adults in the country smoke cigarettes and 58 million nonsmokers are exposed to secondhand smoke.

It is also estimated that about 2,000 young people under 18 smoke their first cigarette every day, and more than 300 become daily cigarette smokers.

Statistics on youth smokers have been much in the news recently as a result of what has been labeled a public health crisis — the enormous popularity of flavored e-cigarettes with both high and middle school students and the fact that many of them are unaware their e-liquids contain relatively high amounts of the addictive substance naturally occurring in tobacco — nicotine.

E-cigarettes, which do not burn tobacco, have been promoted as a smoking cessation tool for smokers of combustible cigarettes.

This may prove true for some smokers who have not had success with nicotine replacement therapy medications, though more long-term studies are needed to see how effective e-cigarettes are in actually ending an addiction to nicotine, as well as how safe.

They are not approved by the FDA for this purpose.

What is true about smoking cessation strategies is that they are most effective when they include some type of behavioral therapy support, such as individual counseling.

A recent study for which I was a contributing author looked at why hospitalized smokers eligible to attend cardiac rehabilitation programs do not attend cardiac rehab, even though this would help them quit smoking.

Those surveyed responded that they had an interest in smoking cessation and medication therapy as well as exercise and counseling, but a high percentage indicated levels of depression and anxiety at discharge and indicated that if stress management programs were included, then they would be more likely to attend.

Another study I helped author looked back over a 10-year period at smoking cessation medications administered to patients hospitalized at some 282 hospitals for coronary heart disease across the United States.

We found only a minority of patients received any treatment and that hospitals administering it increased only modestly over the 10 years.

Public insurance plans, including MassHealth and Medicare, generally cover FDA-approved nicotine replacement medicines and a certain number of counseling sessions to help smokers quit. Those with private insurance should check for cost-sharing as well as benefits covered. If you smoke, or know someone who smokes and wants to quit, using medications can really help reduce withdrawal and cravings and increase your chances for long-term success.

There are also many useful resources for quitting. 1-800-QUIT-NOW is a free smoking cessation coaching service that is paid for by cigarette taxes. Free medications (patches, gum, and more) are sometimes available. Also, smokefree.gov is a completely free online resource that has a text message system that can really help.

During American Heart Month, Baystate presents a free series of Sunday talks on heart health and I will be speaking on current topics in the news in the presentation, “Heart Disease Hot Topics: Vaping, E-Cigarettes, Marijuana and Alcohol — Harmless or Destructive? What Patients with Heart Disease Need to Know,” Feb. 23 from noon to 2 p.m. at the Baystate Health Education Center, 361 Whitney Ave., Holyoke. Registration is required for each session by visiting baystatehealth.org/events, or calling 413-794-5200.

Dr. Quinn Pack is a preventive cardiologist with the Heart & Vascular Program at Baystate Medical Center. He is also an Associate Professor of Medicine with the University of Massachusetts Medical School — Baystate.



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