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 Researchers looked at nearly 14,000 patients
hospitalized with blockages in arteries supplying the heart muscle
and found smokers were more likely than nonsmokers to die within a
year.
Despite their being younger, and otherwise healthier, the smokers'
heart arteries were in a condition similar to those of nonsmokers 10
years older.
"We saw smokers presenting the disease at age 55 and nonsmokers
presenting the same disease at 65," said Dr. Alexandra Lansky, a
researcher on the study.
Smoking can cause blood clots, which often get lodged in the rigid
and narrow arteries that have already been clogged by the buildup of
cholesterol and fat deposits, according to Lansky and her
colleagues.
Although the fat buildup and stiffening of the artery walls, known
as atherosclerosis, becomes more likely with age for everyone, the
clots caused by smoking worsen the blockages.
That makes smokers more likely to have a heart attack at a younger
age, but less likely to have the other conditions, known as
comorbidities, that go along with aging, such as diabetes and high
blood pressure.
"Smoking accelerates the manifestation of coronary disease but in
the absence of these comorbidities," Lansky told Reuters Health.
Past research has identified a "smoker's paradox" - because smokers
are younger, with fewer other health problems, when they had a heart
attack, they were more likely to recover it. Or so it seemed.
"We wanted to look at longer-term effects of smoking rather just the
short term effect," Lansky said.
The researchers analyzed medical records for 13,819 patients, almost
4,000 of them smokers, hospitalized with chest pain or a heart
attack caused by a blocked coronary artery.
The study team organized the data to match the smokers and
nonsmokers by age, weight, comorbidities and other risk factors.
When compared to nonsmokers with similar overall health, the smokers
were ten years younger, on average, and more likely to have already
been treated with blood thinners - suggesting they had already
experienced problems with blood flow.
Imaging of the coronary artery showed the smokers' had
atherosclerosis comparable to the nonsmokers ten years their senior,
the researchers report in the journal JACC: Cardiovascular
Interventions.
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Before the adjustments for age and other health conditions, the
smokers and nonsmokers were about equally likely to survive the
first 30 days after hospitalization, and smokers were about 20
percent less likely to die within a year.
But once smokers and nonsmokers with similar health profiles were
compared to each other, the smokers were 37 percent more likely to
die within the first year.
"What makes it novel, is that we are showing that if you come in,
your chance of survival is already reduced, as a smoker," Lansky
said.
The findings are not surprising, according to Dr. Robert Giugliano,
a cardiologist at Brigham and Women's Hospital in Boston.
"Nonetheless, the public does need to know that there is now even
more evidence that smoking is bad for your health, accelerates the
process of atherosclerosis (so smokers have heart and vascular
disease on average 10 years early than non-smokers), and leads to
worse outcomes compared to non-smokers of a similar age," said
Giugliano, who also teaches at Harvard Medical School.
Dr. Elliot Antman, also of Brigham and Women's Hospital and Harvard,
said it would be interesting to follow the patients for longer than
a year to see what happened to survival rates among smokers who
quit.
Antman was not surprised by the findings either. "I always suspected
this was the case but it is nice to see the data," he told Reuters
Health.
"There just aren't many healthy people in their 80's who smoke
regularly . . . if you want to live a healthy, long life, smoking
stacks the odds against you," Giugliano said.
 ___
Source: http://bit.ly/1g8o9sK
JACC: Cardiovascular Interventions, online March 14, 2014.
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