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(Circulation. 2000;102:1340.)
© 2000 American Heart Association, Inc.

Editorial

Cigarette Smoking

How Much Worse Can It Get?

Robert M. Califf, MD

From the Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.

Correspondence to Robert M. Califf, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail calif001@mc.duke.edu

Key Words: Editorials • myocardial infarction • coronary disease • atherosclerosis • smoking • risk factors

The barrage of negative information about cigarette smoking seems never ending. In addition to the association between cigarette smoking and the development of coronary heart disease, chronic lung disease, and many forms of cancer, we now learn that patients who continue smoking after percutaneous coronary intervention (PCI) have a smaller benefit in quality of life and functional status than patients who did not smoke and patients who quit after the procedure. The meticulous work of Cohen and colleagues¹ documents this phenomenon beyond any doubt, and their information can be readily translated into direct discussions with patients.

Because most PCIs are performed in circumstances in which substantial survival benefit is not a realistic expectation, the major reason for doing such procedures is to improve functional status. A patient who continues to smoke after PCI receives about one-half the benefit as someone who stops smoking and only one-third the benefit as someone who never smoked.

This study brings to mind several issues that may be worthy of consideration by readers of Circulation. First, why do we not measure important ancillary issues more often when we do a first-rate clinical trial? Second, given the mountain of evidence indicating that smoking will probably shorten smokers’ lives and the lives of people around them and increase the chance that such people will be functionally miserable, what on earth possesses people to smoke? Third, what is our obligation regarding using expensive medical care technologies in people who continue to smoke? And finally, what financial responsibility . . . [Full Text of this Article]

This article has been cited by other articles:

				D. S. David Cigarette Smoking: How Much Worse Can It Get? Circulation, June 26, 2001; 103 (25): e128 - e128. [Full Text] [PDF]