Self-reported Smoking Status and Exhaled Carbon Monoxide in Secondary Preventive Follow-up After Coronary Heart Events: Do Our Patients Tell the Truth?

Overview

Journal Tob Prev Cessat

Date 2024 Sep 26

PMID 39323439

Authors

Anete Kaldal

Serena Tonstad

Jarle Jortveit

Affiliations

Soon will be listed here.

Abstract

Introduction: Smoking cessation reduces the risk of myocardial infarctions (MI) and death in patients with coronary heart disease. Smoking status is frequently assessed based on self-report. The aims of this study were to compare self-reported and objectively measured (exhaled carbon monoxide [eCO]) smoking status after MI, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG), and to assess whether assumed wrongly declared smoking cessation was associated to poorer achievement of other treatment targets for secondary prevention.

Methods: This study was a sub-analysis from a randomized controlled trial at Sorlandet Hospital, Arendal, Norway, 2007-2022, including patients hospitalized due to MI or after scheduled PCI/CABG, and primarily aimed at comparing secondary preventive follow-up in the outpatient clinic versus primary healthcare. Participants were followed up after the index event through outpatient consultations. Smoking status was assessed by self-report and by eCO (Smokerlyzer, Bedfont, UK) with concentration values ≥6 ppm interpreted as suggesting smoking.

Results: A total of 1540 participants aged 18-80 years were included in the main study. Self-reported smoking status and concomitant eCO measurement one year after the index event were available in 1291 (84%) participants. In all, Brussels, Belgium, from the 12th to the 13th of September 2024. The concentration of eCO was ≥6 ppm one year after the index event in 285 (22%) patients, and 72 (25%) of these patients reported non-smoking. Fewer patients with elevated eCO reporting non-smoking achieved the treatment target for blood pressure (<140/90 mmHg) in comparison to those reporting smoking (53% vs 68%, p=0.02). No differences for the other treatment targets for secondary prevention were found.

Conclusions: The study indicates a need for objective measures for smoking cessation both in clinical studies and in clinical practice, and may indicate a lack of truthfulness regarding smoking habits.

Clinical Trial Registration: The study is registered on the official website of ClinicalTrials.gov.

Identifier: ID NCT00679237.

References

Visseren F, Mach F, Smulders Y, Carballo D, Koskinas K, Back M . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484. View

Piepoli M, Hoes A, Agewall S, Albus C, Brotons C, Catapano A . 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by.... Eur Heart J. 2016; 37(29):2315-2381. PMC: 4986030. DOI: 10.1093/eurheartj/ehw106. View

Asvold B, Bjorngaard J, Carslake D, Gabrielsen M, Skorpen F, Davey Smith G . Causal associations of tobacco smoking with cardiovascular risk factors: a Mendelian randomization analysis of the HUNT Study in Norway. Int J Epidemiol. 2014; 43(5):1458-70. DOI: 10.1093/ije/dyu113. View

Tun B, Ehrbar R, Short M, Cheng S, Vasan R, Xanthakis V . Association of Exhaled Carbon Monoxide With Ideal Cardiovascular Health, Circulating Biomarkers, and Incidence of Heart Failure in the Framingham Offspring Study. J Am Heart Assoc. 2020; 9(21):e016762. PMC: 7763395. DOI: 10.1161/JAHA.120.016762. View

Stelmach R, Fernandes F, Carvalho-Pinto R, Athanazio R, Zahi Rached S, Prado G . Comparison between objective measures of smoking and self-reported smoking status in patients with asthma or COPD: are our patients telling us the truth?. J Bras Pneumol. 2015; 41(2):124-32. PMC: 4428849. DOI: 10.1590/S1806-37132015000004526. View

Jortveit J, Halvorsen S, Kaldal A, Pripp A, Govatsmark R, Langorgen J . Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease. BMC Cardiovasc Disord. 2019; 19(1):71. PMC: 6437860. DOI: 10.1186/s12872-019-1062-y. View

Prugger C, Wellmann J, Heidrich J, De Bacquer D, De Backer G, Perier M . Readiness for smoking cessation in coronary heart disease patients across Europe: Results from the EUROASPIRE III survey. Eur J Prev Cardiol. 2014; 22(9):1212-9. DOI: 10.1177/2047487314564728. View

. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of.... Lancet. 2018; 392(10159):1923-1994. PMC: 6227755. DOI: 10.1016/S0140-6736(18)32225-6. View

Linneberg A, Jacobsen R, Skaaby T, Taylor A, Fluharty M, Jeppesen J . Effect of Smoking on Blood Pressure and Resting Heart Rate: A Mendelian Randomization Meta-Analysis in the CARTA Consortium. Circ Cardiovasc Genet. 2015; 8(6):832-41. PMC: 4684098. DOI: 10.1161/CIRCGENETICS.115.001225. View

10.

Benowitz N, Bernert J, Foulds J, Hecht S, Jacob P, Jarvis M . Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine Tob Res. 2019; 22(7):1086-1097. PMC: 7882145. DOI: 10.1093/ntr/ntz132. View

11.

Chatrchaiwiwatana S, Ratanasiri A . EXHALED CARBON MONOXIDE LEVELS AMONG TOBACCO SMOKERS BY AGE. Southeast Asian J Trop Med Public Health. 2018; 48(2):429-37. View

12.

Veit T, Munker D, Leuschner G, Mummler C, Sisic A, Kauke T . High prevalence of falsely declaring nicotine abstinence in lung transplant candidates. PLoS One. 2020; 15(6):e0234808. PMC: 7302701. DOI: 10.1371/journal.pone.0234808. View

13.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur Heart J. 2012; 33(13):1635-701. DOI: 10.1093/eurheartj/ehs092. View

14.

Maga M, Janik M, Wachsmann A, Chrzastek-Janik O, Koziej M, Bajkowski M . Influence of air pollution on exhaled carbon monoxide levels in smokers and non-smokers. A prospective cross-sectional study. Environ Res. 2016; 152:496-502. DOI: 10.1016/j.envres.2016.09.004. View

15.

Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D . European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J. 2022; 43(8):716-799. DOI: 10.1093/eurheartj/ehab892. View

16.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

17.

Middleton E, Morice A . Breath carbon monoxide as an indication of smoking habit. Chest. 2000; 117(3):758-63. DOI: 10.1378/chest.117.3.758. View

18.

Li G, Wang H, Wang K, Wang W, Dong F, Qian Y . The association between smoking and blood pressure in men: a cross-sectional study. BMC Public Health. 2017; 17(1):797. PMC: 5634904. DOI: 10.1186/s12889-017-4802-x. View

19.

Kaldal A, Tonstad S, Jortveit J . Long-term hospital-based secondary prevention of coronary artery disease: a randomized controlled trial. BMC Cardiovasc Disord. 2021; 21(1):600. PMC: 8679993. DOI: 10.1186/s12872-021-02426-3. View

20.

Mach F, Baigent C, Catapano A, Koskinas K, Casula M, Badimon L . 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2019; 41(1):111-188. DOI: 10.1093/eurheartj/ehz455. View