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Smoking Cessation and Prognosis in Patients with LV Dysfunction

Smoking is a strong risk factor for development of both coronary heart disease and congestive heart failure (CHF), but what is the effect of smoking cessation on prognosis in patients with left ventricular (LV) dysfunction? Investigators retrospectively analyzed outcome data on more than 6700 people enrolled in the Study of Left Ventricular Dysfunction (SOLVD) Prevention and Intervention trials. Subjects were classified as current smokers, ex-smokers for 2 years or less, ex-smokers for longer than 2 years, or never-smokers according to their status when they were enrolled in the SOLVD trials.

After adjusting for clinical factors such as age, ejection fraction, race, and etiology of heart failure, current smokers had significantly higher risk for overall mortality (RR, 1.41) than did ex-smokers or never-smokers, and there was a trend toward higher CHF mortality among smokers. Smokers also had significantly higher risk for the combined endpoint of death, myocardial infarction, or recurrent hospitalization for heart failure (RR, 1.39). There was no significant difference in this combined endpoint between ex-smokers and never-smokers.

Comment: In this study, smoking had a strong independent effect on outcome in patients with LV dysfunction. These researchers found that the benefits of not smoking were of similar magnitude to the benefits associated with conventional drug therapies for heart failure. Moreover, the increased risk dissipated within 2 years of quitting, which suggests that aggressive efforts to help these patients quit are warranted.

— KE Fleischmann

Published in Journal Watch General Medicine June 15, 2001

Citation(s):

Suskin N et al. Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol 2001 May 37 1677-1682.

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