Abstract 2093: Does Smoker’s Paradox Exist in African Americans with Myocardial Infarction?
Background: Smoking is an established risk factor for cardiovascular disease, but studies have shown that smokers with myocardial infarction (MI) have lower mortality rates than non-smokers. Whether this is true among African American (AA) MI patients and for a prolonged follow-up is not known.
Methods: 395 AA patients were enrolled in a prospective MI registry in one of the largest urban public hospital in the metropolitan Atlanta. Smoking behavior was assessed by self-report during the MI hospitalization. Multivariable models were used to examine the association between smokers and 3-year all cause mortality after adjusting for demographic, clinical, and quality of care variables.
Results: Forty-three percent of patients (n=170) were smokers at the time of MI hospitalization. Smokers were significantly younger (52.9 yrs vs. 59.7 yrs) and more likely to be male (58.2% vs. 46.6%) compared with non smokers. The odds of 3 year mortality (Fig I⇓) were greater among those who were older (Odds Ratio (OR) =1.05 per year of age, 95% CI=1.02, 1.08); had no insurance (OR=2.86, 95% CI=1.48, 5.54) and had hypercholesterolemia (OR=1.73, 95% CI=0.98, 3.05). However, being a smoker at the time of MI did not predict 3 year all cause mortality (OR=1.04, 95% CI 0.57–1.88). The model c-statistic was 0.78.
Conclusions: While the “smoker’s paradox” may not be present among AA patients with MI, the reason why smoking is not associated with higher mortality needs further exploration including potential pathophysiological explanations. To that end, data clearly show the importance of not smoking and smoking cessation in overall cardiovascular health.
This research has received full or partial funding support from the American Heart Association, AHA Greater Southeast Affiliate (Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico & Tennessee).