A new study shows that the cardiovascular health benefits of smoking cessation persist even when quitting at an older age.
Over 37 000 deaths in Canada are caused by smoking-related diseases annually, including cardiovascular-related causes. The incidence of cardiovascular disease increases with age, however, smoking is a major modifiable risk factor. The current study aimed to address the cardiovascular effect(s) of smoking and smoking cessation in adults over the age of 60. A total of 503 905 participants were enrolled in the trial. Participants were over the age of 60, with an average follow up time of between 8-13 years, making up one of the largest studies on link between smoking and cardiovascular disease-related mortality in older adults.
The results of the study show that, in this age group, smoking is strongly linked with coronary events, stroke, and cardiovascular deaths. The calculated risk of dying from cardiovascular disease was brought forward by 5.5 years in smokers, compared with never smokers. A greater increase in risk was observed with increasing amounts of cigarettes smoked. Conversely, the risk decreased as time passed following smoking cessation.
Few studies have addressed the effect of smoking cessation in older age. The results of the current study show that there are considerable cardiovascular benefits to smoking cessation, even in later life, which could reduce the burden of cardiovascular disease. The authors suggest that public health campaigns should also be targeted to this age group, who can still have significant health benefits from quitting.
There are various approaches available to smoking cessation, several of which are the subject of current clinical trials.
Mindfullness-Based Smoking Cessation
In an effort to circumvent the side-effects associated with pharmacotherapy for smoking cessation, a study is recruiting participants to take part in a mindfulness-based approach to quitting. The study, taking place at the University of Virginia, Charlottesville, Virginia, United States, will include male and female participants who are 18 years of age or older, and smoke a minimum of 5 cigarettes daily. Participants must demonstrate that they want to quit smoking, which will be assessed via a ‘Readiness to Change’ questionnaire. In this study, mindfulness-based therapy will be directly compared with behavioural therapy for smoking cessation. Mindfulness-based therapy is based on learning to pro-actively observe body and mind states, rather than reacting with habitual responses. In contrast, behavioural therapy is the process of replacing bad habits with good ones. Mindfulness-based therapies have shown promising results in studies of anxiety, depression, and addictions. In the current study, both forms of therapy will be administered via mobile phone applications.
Varenicline is a drug that mimics nicotine in the body, interfering with nicotine receptors in the brain. By doing this it can decrease both the urge to smoke, and reduce withdrawal symptoms for people who are trying to quit smoking. A clinical trial being conducted at Icahn School of Medicine at Mount Sinai, New York, United States, aims to assess varenicline as an aid in scheduled gradual reduction of smoking. During the scheduled gradual reduction, participants will be allocated fixed intervals at which they may consume cigarettes. The allocated smoking times will be gradually reduced over the study period. Participants will be eligible for the study if they are over the age of 18 and have smoked at least 10 cigarettes per day for the past 5 years.
E-Cigarettes as Quitting Aids
A study evaluating the use of e-cigarettes as an aid for smoking cessation is recruiting participants in Canada. The study is being conducted by McGill University and Jewish General Hospital, and is recruiting active smokers over the age of 18, who smoke more than 10 cigarettes per day. The advantage of an e-cigarette is that it feels like smoking a cigarette, and so may be helpful for some smokers as a quitting aid. This will be the first large trial to assess e-cigarettes for smoking cessation in Canada. The trial will compare the use of nicotine-containing e-cigarettes with non-nicotine-containing e-cigarettes. Information from this trial will have important implications, since the use of e-cigarettes as a device for smoking cessation has not yet been approved by Health Canada or the FDA.
Mons, U, Müezzinler,A, Gellert, C, Schöttker, B, Abnet, CC, Bobak, M, de Groot, L, Freedman, ND, Jansen, E, Kee, F, Kromhout, D, Kuulasmaa, K, Laatikainen, T, O’Doherty, MG, Bueno-de-Mesquita, B, Orfanos, P, Peters, A, van der Schouw, YT, Wilsgaard, T, Wolk, A, Trichopoulou, A, Boffetta, P, Brenner, H, on behalf of the CHANCES consortium “Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium” BMJ 2015;350:h1551
clinicaltrials.gov “A Mindfulness Based Application for Smoking Cessation (MBSC)” Available from: https://www.clinicaltrials.gov/ct2/show/NCT01982110?term=smoking+cessation&recr=Open&no_unk=Y&rank=5 Last Accessed: April 30, 2015.
clinicaltrials.gov “A Smoking Intervention Study Using Scheduled Gradual Reduction With Varenicline to Help With Cessation” Available from: https://www.clinicaltrials.gov/ct2/show/NCT01772641?term=varenicline&recr=Open&no_unk=Y&rank=8 Last Accessed: April 30, 2015.
clinicaltrials.gov “Evaluating the Efficacy of E-Cigarette Use for Smoking Cessation (E3) Trial” Available from: https://www.clinicaltrials.gov/ct2/show/NCT02417467?term=smoking+cessation&recr=Open&no_unk=Y&rank=23 Last Accessed: April 30, 2015.
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Written by Deborah Tallarigo, PhD