Current Smoking, Smoking Cessation, and the Risk of Sudden Cardiac Death in Patients With Coronary Artery Disease
This journal article describes a study evaluating the effect of cigarette smoking on sudden cardiac death (SCD) in a large cohort of patients with established coronary artery disease (CAD). The study population consisted of 3,122 patients with previous myocardial infarction or stable angina who participated in the Israeli Bezafibrate Infarction Prevention Trial. Patients were prospectively followed up for a mean of 8.2 years. The primary endpoint was the incidence of SCD according to smoking status. Among the 370 patients who were current smokers, 30 experienced SCD. Eighty-three of the 1,821 patients who had quit smoking and 43 of the 931 patients who had never smoked experienced SCD. Current smokers also had a substantially greater cardiac-related and all-cause mortality rate compared with never smokers and past smokers. The risk of SCD did not increase in patients who smoked more cigarettes per day, but it did increase with increased duration of smoking for current and past smokers. There was no correlation between the risk of SCD and the number of years without smoking in patients who had quit smoking before randomization. In multivariate analyses, current smoking was associated with a significant increase in the risk of SCD (hazard ratio=2.47). Patients who had quit smoking had no significant increase in the risk of SCD compared with patients who had never smoked. Current cigarette smoking is a powerful independent predictor of SCD risk in patients with CAD (hazard ratio=2.47). Patients who quit smoking experienced a significant reduction in SCD risk. Thus, efforts to reduce mortality from SCD in patients with CAD should include vigorous smoking cessation strategies.
