Abstract 13483: Impact of Smoking on Cardiovascular Events in Patients With Established Coronary Disease Receiving Contemporary Medical Therapy: a Post Hoc Analysis of the Treating to New Targets (TNT) & the Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Trials
Objective: To define the incremental risk of cigarette smoking in coronary patients receiving contemporary medical therapy.
Methods and Results: We performed a post hoc analysis of 18,885 patients by combining data from the Treating to New Targets (TNT) and the Incremental Decrease in End Points through Aggressive Lipid Lowering (IDEAL) Trials. These studies compared high-dose treatment (atorvastatin 80 mg/day) to moderate-dose treatment (atorvastatin 10 mg/day in TNT and simvastatin 20 to 40 mg/day in IDEAL) in pa tients with established coronary heart disease. The primary endpoint of this pooled analysis was major cardiovascular events (MCVE), a composite of cardiac death, myocardial infarction, stroke or resuscitated cardiac arrest. At baseline 4,196 patients had never smoked, 11,513 were ex-smokers and 3,176 were current smokers. Overall the unadjusted risk of the primary endpoint was similar between never smokers and ex-smokers and elevated for current smokers (see Figure). The adjusted risk was even higher, for current smokers compared to never smokers (HR 1.68, 95% CI 1.46 – 1.94) and current smokers compared to ex-smokers (HR 1.57, 95% CI 1.41 – 1.76). Event rates for current smokers compared to ex-smokers remained elevated regardless of treatment groups (atorvastatin 80mg/day group HR 1.54, 95% CI 1.30 – 1.82 vs. simvastatin 20 to 40mg/day group HR 1.55, 95% CI 1.27 – 1.89 vs. atorvastatin 10mg/day 1.66, 95% CI 1.31 – 2.09). The difference in absolute event rates between current and ex-smokers in this pooled analysis was 4.5% which is more than twice as large as the decrease in absolute event rates between high-dose and moderate-dose statin therapy found in the IDEAL (1.7%) and the TNT (2.2%) trials respectively.
Conclusion: In coronary patients receiving modern medical therapy, smoking cessation is of substantial benefit with a NNT of 22 to prevent a major cardiovascular event over 5 years. Smoking cessation deserves greater emphasis in secondary prevention.
- © 2010 by American Heart Association, Inc.