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. 2022 Aug 8;8(8):CD014936.
doi: 10.1002/14651858.CD014936.pub2.

Smoking cessation for secondary prevention of cardiovascular disease

Angela Difeng Wu  1 , Nicola Lindson  1 , Jamie Hartmann-Boyce  1 , Azizia Wahedi  2 , Anisa Hajizadeh  1 , Annika Theodoulou  1 , Elizabeth T Thomas  1 , Charlotte Lee  1 , Paul Aveyard  1
Affiliations

Smoking cessation for secondary prevention of cardiovascular disease

Angela Difeng Wu et al. Cochrane Database Syst Rev. .

Abstract

Background: Smoking is a leading cause of cardiovascular disease (CVD), particularly coronary heart disease (CHD). However, quitting smoking may prevent secondary CVD events in people already diagnosed with CHD. OBJECTIVES: To examine the impact of smoking cessation on death from CVD and major adverse cardiovascular events (MACE), in people with incident CHD.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the trials registries clinicaltrials.gov and the International Clinical Trials Registry Platform. We ran all searches from database inception to 15 April 2021. SELECTION CRITERIA: We included cohort studies, and both cluster- and individually randomised controlled trials of at least six months' duration. We treated all included studies as cohort studies and analysed them by smoking status at follow-up. Eligible studies had to recruit adults (> 18 years) with diagnosed CHD and who smoked tobacco at diagnosis, and assess whether they quit or continued smoking during the study. Studies had to measure at least one of our included outcomes with at least six months' follow-up. Our primary outcomes were death from CVD and MACE. Secondary outcomes included all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, new-onset angina and change in quality of life. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods for screening and data extraction. We assessed the risk of bias for the primary outcomes using the ROBINS-I tool. We compared the incidence of death from CVD and of MACE (primary outcomes) between participants who quit smoking versus those who continued to smoke for each included study that reported these outcomes. We also assessed differences in all-cause mortality, incidence of non-fatal myocardial infarction, incidence of non-fatal stroke and new onset angina. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI). For our outcome, change in quality of life, we calculated the pooled standardised mean difference (SMD) and 95% CI for the difference in change in quality of life from baseline to follow-up between those who had quit smoking and those who had continued to smoke. For all meta-analyses we used a generic inverse variance random-effects model and quantified statistical heterogeneity using the I²statistic. We assessed the certainty of evidence for our primary outcomes using the eight GRADE considerations relevant to non-randomised studies.

Main results: We included 68 studies, consisting of 80,702 participants. For both primary outcomes, smoking cessation was associated with a decreased risk compared with continuous smoking: CVD death (HR 0.61, 95% CI 0.49 to 0.75; I² = 62%; 18 studies, 17,982 participants; moderate-certainty evidence) and MACE (HR 0.57, 95% CI 0.45 to 0.71; I² = 84%; 15 studies, 20,290 participants; low-certainty evidence). These findings were robust to our planned sensitivity analyses. Through subgroup analysis, for example comparing adjusted versus non-adjusted estimates, we found no evidence of differences in the effect size. While there was substantial heterogeneity, this was primarily in magnitude rather than the direction of the effect estimates. Overall, we judged 11 (16%) studies to be at moderate risk of bias and 18 (26%) at serious risk, primarily due to possible confounding. There was also some evidence of funnel plot asymmetry for MACE outcomes. For these reasons, we rated our certainty in the estimates for CVD death as moderate and MACE as low. For our secondary outcomes, smoking cessation was associated with a decreased risk in all-cause mortality (HR 0.60, 95% CI 0.55 to 0.66; I² = 58%; 48 studies, 59,354 participants), non-fatal myocardial infarction (HR 0.64, 95% CI 0.58 to 0.72; I² = 2%; 24 studies, 23,264 participants) and non-fatal stroke (HR 0.70, 95% CI 0.53 to 0.90; I² = 0%; 9 studies, 11,352 participants). As only one study reported new onset of angina, we did not conduct meta-analysis, but this study reported a lower risk in people who stopped smoking. Quitting smoking was not associated with a worsening of quality of life and suggested improvement in quality of life, with the lower bound of the CI also consistent with no difference (SMD 0.12, 95% CI 0.01 to 0.24; I² = 48%; 8 studies, 3182 participants). AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that smoking cessation is associated with a reduction of approximately one-third in the risk of recurrent cardiovascular disease in people who stop smoking at diagnosis. This association may be causal, based on the link between smoking cessation and restoration of endothelial and platelet function, where dysfunction of both can result in increased likelihood of CVD events. Our results provide evidence that there is a decreased risk of secondary CVD events in those who quit smoking compared with those who continue, and that there is a suggested improvement in quality of life as a result of quitting smoking. Additional studies that account for confounding, such as use of secondary CVD prevention medication, would strengthen the evidence in this area.

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Conflict of interest statement

ADW: none

JHB: none

NL: none

PA: none

Figures

1
1
PRISMA flow diagram of studies
2
2
Risk‐of‐bias: 'traffic light' plot of the domain‐level judgements for each individual result according to the ROBINS‐I tool
3
3
Risk‐of‐bias: weighted bar plot of the distribution of risk‐of‐bias judgements within each bias domain according to the ROBINS‐I tool
4
4
Funnel plot of comparison 1. Main analysis: difference in change (from baseline to longest follow‐up) between people who quit and people who continued smoking, outcome: 1.1 primary outcome: death from cardiovascular disease
5
5
Funnel plot of comparison 2. Main analysis: difference in change (from baseline to longest follow‐up) between people who quit and people who continued smoking, outcome: 2.1 primary outcome: major adverse cardiovascular events
6
6
Funnel plot of outcome 3.1 all‐cause mortality
7
7
Funnel plot of outcome 4.1 non‐fatal myocardial infarction
1.1
1.1. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 1: Main data analysis for death from cardiovascular disease
1.2
1.2. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 2: Sensitivity analysis: risk of bias
1.3
1.3. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 3: Sensitivity analysis: using unadjusted estimates for studies that report both adjusted and unadjusted
1.4
1.4. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 4: Subgroups: adjusted versus unadjusted estimates
1.5
1.5. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 5: Subgroups: reporting hazard ratios (HRs) versus approximating risk ratio (RR)
1.6
1.6. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 6: Subgroups: biochemical validation versus no biochemical validation
1.7
1.7. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 7: Subgroups: presence of secondary medication prevention
1.8
1.8. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 8: Subgroups: sex of population
1.9
1.9. Analysis
Comparison 1: Death from cardiovascular disease, Outcome 9: Sensitivity analysis: longer than 2‐year follow‐up
2.1
2.1. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 1: Main data analysis for MACE
2.2
2.2. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 2: Sensitivity analysis: risk of bias
2.3
2.3. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 3: Sensitivity analysis: using unadjusted estimates for studies that report both adjusted and unadjusted
2.4
2.4. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 4: Subgroups: adjusted versus unadjusted estimates
2.5
2.5. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 5: Subgroups: reporting hazard ratios (HRs) versus approximating risk ratio (RR)
2.6
2.6. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 6: Subgroups: biochemical validation versus no biochemical validation
2.7
2.7. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 7: Subgroups: presence of secondary medication prevention
2.8
2.8. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 8: Subgroups: sex of population
2.9
2.9. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 9: Subgroups: definition of MACE
2.10
2.10. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 10: Sensitivity analysis: longer than 2‐year follow‐up
2.11
2.11. Analysis
Comparison 2: Major adverse cardiovascular events (MACE), Outcome 11: Sensitivity analysis: removing Imbalzano 2018
3.1
3.1. Analysis
Comparison 3: All‐cause mortality, Outcome 1: All‐cause mortality
4.1
4.1. Analysis
Comparison 4: Non‐fatal myocardial infarction, Outcome 1: Non‐fatal myocardial infarction
5.1
5.1. Analysis
Comparison 5: Non‐fatal stroke, Outcome 1: Non‐fatal stroke
6.1
6.1. Analysis
Comparison 6: Quality of life, Outcome 1: Quality of life
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References

References to studies included in this review

Aberg 1983 {published data only}
    1. Aberg A, Bergstrand R, Johansson S, Ulvenstam G, Vedin A, Wedel H, et al. Cessation of smoking after myocardial infarction. Effects on mortality after 10 years. British Heart Journal 1983;49(5):416-22. - PMC - PubMed
Alvarez 2011 {published data only}
    1. Alvarez LR, Balibrea JM, Surinach JM, Coll R, Pascual MT, Toril J, et al. Smoking cessation and outcome in stable outpatients with coronary, cerebrovascular, or peripheral artery disease. European Journal of Preventive Cardiology 2011;20(3):486-95. - PubMed
Baughman 1982 {published data only}
    1. Baughman KL, Hutter AM Jr, DeSanctis RW, Kallman CH. Early discharge following acute myocardial infarction. Long-term follow-up of randomized patients. Archives of Internal Medicine 1982;142(5):875-8. - PubMed
Bednarzewski 1984 {published data only}
    1. Bednarzewski J. Does stopping tobacco smoking affect long-term prognosis after myocardial infarction? . Wiadomosci Lekarskie (Warsaw, Poland) 1984;37(8):569-76. - PubMed
Biery 2020 {published data only}
    1. Biery DW, Berman AN, Singh A, Divakaran S, DeFilippis EM, Collins BL, et al. Association of smoking cessation and survival among young adults with myocardial infarction in the partners YOUNG-MI registry. JAMA Network Open 2020;3(7):e209649. - PMC - PubMed
Boggon 2014 {published data only}
    1. Boggon R, Timmis A, Hemingway H, Raju S, Malvestiti FM, Van Staa TP. Smoking cessation interventions following acute coronary syndrome: a missed opportunity? European Journal of Preventive Cardiology 2014;21(6):767-73. - PMC - PubMed
Breitling 2011 {published data only}
    1. Breitling LP, Rothenbacher D, Vossen CY, Hahmann H, Wusten B, Brenner H. Validated smoking cessation and prognosis in patients with stable coronary heart disease. Journal of the American College of Cardiology 2011;58(2):196-7. - PubMed
Buchanan 2015 {published data only}
    1. Buchanan DM, Arnold SV, Gosch KL, Jones PG, Longmore LS, Spertus JA, et al. Association of smoking status with angina and health-related quality of life after acute myocardial infarction. Circulation: Cardiovascular Quality and Outcomes 2015;8(5):493-500. - PMC - PubMed
Burr 1992 {published data only}
    1. Burr ML, Holliday RM, Fehily AM, Whitehead PJ. Haematological prognostic indices after myocardial infarction: evidence from the diet and reinfarction trial (DART). European Heart Journal 1992;13(2):166-70. - PubMed
Cavender 1992 {published data only}
    1. Cavender JB, Rogers WJ, Fisher LD, Gersh BJ, Coggin CJ, Myers WO. Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the Coronary Artery Surgery Study (CASS): 10-year follow-up. CASS Investigators. Journal of the American College of Cardiology 1992;20(2):287-94. - PubMed
Cha 2018 {published data only}
    1. Cha S, Lee Y, Kim W, Paik N, Park J, Kim S. Need for systematic efforts to modify health-related behaviors after acute myocardial infarction in Korea. Circulation Journal 2018;82(10):2523-9. - PubMed
Chow 2010 {published data only}
    1. Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010;121(6):750-8. - PubMed
Colivicchi 2011 {published data only}
    1. Colivicchi F, Mocini D, Tubaro M, Aiello A, Clavario P, Santini M. Effect of smoking relapse on outcome after acute coronary syndromes. American Journal of Cardiology 2011;108(6):804-8. - PubMed
Cordero 2012 {published data only}
    1. Cordero A, Bertomeu-Martinez V, Mazon P, Cosin J, Galve E, Lekuona I, et al. Attitude and efficacy of cardiologists with respect to smoking in patients after acute coronary syndromes. Revista Espanola De Cardiologia 2012;65(8):719-25. - PubMed
Daly 1985 {published data only}
    1. Daly LE, Graham IM, Hickey N, Mulcahy R. Does stopping smoking delay onset of angina after infarction? British Medical Journal (Clinical Research Ed.) 1985;291(6500):935-7. - PMC - PubMed
    1. Daly LE, Mulcahy R, Graham IM, Hickey N. Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction. British Medical Journal (Clinical Research Ed.) 1983;287(6388):324-6. - PMC - PubMed
De Boer 2013 {published data only}
    1. De Boer SP, Serruys PW, Valstar G, Lenzen MJ, De Jaegere PJ, Zijlstra F, et al. Life-years gained by smoking cessation after percutaneous coronary intervention. American Journal of Cardiology 2013;112(9):1311-4. - PubMed
Gerber 2009 {published data only}
    1. Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y. Smoking status and long-term survival after first acute myocardial infarction a population-based cohort study. Journal of the American College of Cardiology 2009;54(25):2382-7. - PubMed
Grand 1992 {published data only}
    1. Grand A, Fichter P, Adeleine P, Huret JF, Pernot F, Shibli H. Effect of tobacco smoking on the incidence of recurrent myocardial infarction. A retrospective study of 208 cases. Annales De Cardiologie Et D'angeiologie 1992;41(2):55-61. - PubMed
Greenwood 1995 {published data only}
    1. Greenwood DC, Muir KR, Packham CJ, Madeley RJ. Stress, social support, and stopping smoking after myocardial infarction in England. Journal of Epidemiology and Community Health 1995;49(6):583-7. - PMC - PubMed
Gupta 1993 {published data only}
    1. Gupta R, Gupta KD, Sharma S, Gupta VP. Influence of cessation of smoking on long term mortality in patients with coronary heart disease. Indian Heart Journal 1993;45:125-9. - PubMed
Haglid 1997 {published data only}
    1. Haglid M, Albertsson P, Westberg S, Karlson BW, Hartford M, Lurje L, et al. Short- and long-term prognosis after coronary artery bypass grafting in relation to smoking habits. Cardiology 1997;88(6):492-7. - PubMed
Hallstrom 1986 {published data only}
    1. Hallstrom AP, Cobb LA, Ray R. Smoking as a risk factor for recurrence of sudden cardiac arrest. New England Journal of Medicine 1986;314(5):271-5. - PubMed
Hammal 2014 {published data only}
    1. Hammal F, Ezekowitz JA, Norris CM, Wild CT, Finegan BA. Smoking status and survival: impact on mortality of continuing to smoke one year after the angiographic diagnosis of coronary artery disease, a prospective cohort study. BMC Cardiovascular Disorders 2014;14(100968539):133. - PMC - PubMed
Hasdai 1997 {published data only}
    1. Hasdai D, Garratt KN, Grill DE, Lerman A, Holmes DR Jr. Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. New England Journal of Medicine 1997;336(11):755-61. - PubMed
Hedback 1993 {published data only}
    1. Hedback B, Perk J, Wodlin P. Long-term reduction of cardiac mortality after myocardial infarction: 10-year results of a comprehensive rehabilitation programme. Europena Heart Journal 1993;14(6):831-5. - PubMed
Herlitz 1995 {published data only}
    1. Herlitz J, Bengtson A, Hjalmarson A, Karlson BW. Smoking habits in consecutive patients with acute myocardial infarction: prognosis in relation to other risk indicators and to whether or not they quit smoking. Cardiology 1995;86(6):496-502. - PubMed
Hickey 1983 {published data only}
    1. Hickey N, Mulcahy R, Daly L, Graham I, O'Donoghue S, Kennedy C. Cigar and pipe smoking related to four year survival of coronary patients. British Heart Journal 1983;49(5):423-6. - PMC - PubMed
Imbalzano 2018 {published data only}
    1. Imbalzano E, Vatrano M, Quartuccio S, Ceravolo R, Ciconte VA, Rotella P, et al. Effect of type D personality on smoking status and their combined impact on outcome after acute myocardial infarction . Clinical Cardiology 2018;41(3):321-5. - PMC - PubMed
Johansson 1985 {published data only}
    1. Johansson S, Bergstrand R, Pennert K, Ulvenstam G, Vedin A, Wedel H, et al. Cessation of smoking after myocardial infarction in women. Effects on mortality and reinfarctions. American Journal of Epidemiology 1985;121(6):823-31. - PubMed
Kievit 2009 {published data only}
    1. Kievit PC, Brouwer MA, Veen G, Aengevaeren WR, Verheugt FW. The smoker's paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome. Journal of Thrombosis and Thrombolysis 2009;27(4):385-93. - PubMed
Leung 2008 {published data only}
    1. Leung S, Gallup D, Mahaffey KW, Cohen M, Antman EM, Goodman SG, et al. Smoking status and antithrombin therapy in patients with non-ST-segment elevation acute coronary syndrome. American Heart Journal 2008;156(1):177-84. - PubMed
Liu 2013 {published data only}
    1. Liu J, Zhu Z, Gao C, Wang Xi, Zhang Y, Jin W, et al. Long-term effect of persistent smoking on the prognosis of Chinese male patients after percutaneous coronary intervention with drug-eluting stent implantation. Journal of Cardiology 2013;62(5):283-8. - PubMed
Lotan 2017 {published data only}
    1. Lotan K, Goldbourt I, Gerber Y. Smoking status and incidence of cancer after myocardial infarction: a follow-up study of over 20 years. American Journal of Medicine 2017;130(9):1084-91. - PubMed
Masoudkabir 2020 {published data only}
    1. Masoudkabir F, Yavari N, Pashang M, Sadeghian S, Jalali A, Karimi A, et al. Smoking cessation after surgery and midterm outcomes of surgical revascularization. Annals of Thoracic Surgery 2020;109(6):1874-9. - PubMed
Mulcahy 1982 {published data only}
    1. Mulcahy R, Hickey N, Graham I, Daly L. The influence of subsequent cigarette smoking habits on causes and mode of death in survivors of unstable angina or myocardial infarction. European Heart Journal 1982;3(2):142-5. - PubMed
Murphy 2020 {published data only}
    1. Murphy A, Dinh D, Koshy A, Farouque O, Yudi M, Clark D, et al. 734 impact of smoking cessation on long term mortality in patients undergoing percutaneous coronary intervention. Heart Lung and Circulation 2020;29 Suppl 2:S366-7.
Nakatani 2007 {published data only}
    1. Nakatani D, Sakata Y, Sato H, Mizuno H, Shimizu M, Suna S, et al. Clinical impact of metabolic syndrome and its additive effect with smoking on subsequent cardiac events after acute myocardial infarction. American Journal of Cardiology 2007;99(7):885-9. - PubMed
Papathanasiou 2007 {published data only}
    1. Papathanasiou A, Milionis H, Toumpoulis I, Kalantzi K, Katsouras C, Pappas K, et al. Smoking cessation is associated with reduced long-term mortality and the need for repeat interventions after coronary artery bypass grafting. European Journal of Cardiovascular Prevention and Rehabilitation 2007;14(3):448-50. - PubMed
Perkins 1985 {published data only}
    1. Perkins J, Dick TB. Smoking and myocardial infarction: secondary prevention. Postgraduate Medical Journal 1985;61(714):295-300. - PMC - PubMed
Piuhola 2019 {published data only}
    1. Piuhola J, Niemela M, Kervinen K, Hypen L, Holmstrom LT, Tulppo M, et al. Three-year outcomes related to coronary stenting; a registry-based real-life population study. Scandinavian Cardiovascular Journal 2019;54:1-7. - PubMed
Qi 2014 {published data only}
    1. Qi Z, Eisenberg MJ, Grandi SM, Joseph L, O'Loughlin J, Paradis G, et al. Bupropion, smoking cessation, and health-related quality of life following an acute myocardial infarction. Journal of Population Therapeutics and Clinical Pharmacology 2014;21:e346-56. - PubMed
Quist‐Paulsen 2006 {published data only}
    1. Quist-Paulsen P, Bakke PS, Gallefoss F. Does smoking cessation improve quality of life in patients with coronary heart disease? Scandinavian Cardiovascular Journal 2006;40(1):11-6. - PubMed
Rallidis 2008 {published data only}
    1. Rallidis LS, Lekakis J, Panagiotakos D, Fountoulaki K, Komporozos C, Apostolou T, et al. Long-term prognostic factors of young patients (<or=35 years) having acute myocardial infarction: the detrimental role of continuation of smoking. European Journal of Cardiovascular Prevention and Rehabilitation 2008;15(5):567-71. - PubMed
Rallidis 2015 {published data only}
    1. Rallidis LS, Sakadakis EA, Tympas K, Varounis C, Zolindaki M, Dagres N, et al. The impact of smoking on long-term outcome of patients with premature (<=35years) ST-segment elevation acute myocardial infarction. American Heart Journal 2015;169(3):356-62. - PubMed
Rea 2002 {published data only}
    1. Rea TD, Heckbert SR, Kaplan RC, Smith NL, Lemaitre RN, Psaty BM. Smoking status and risk for recurrent coronary events after myocardial infarction. Annals of Internal Medicine 2002;137(6):494-500. - PubMed
Ronnevik 1985 {published data only}
    1. Ronnevik PK, Gundersen T, Abrahamsen AM. Effect of smoking habits and timolol treatment on mortality and reinfarction in patients surviving acute myocardial infarction. British Heart Journal 1985;54(2):134-9. - PMC - PubMed
Salonen 1980 {published data only}
    1. Salonen JT. Stopping smoking and long-term mortality after acute myocardial infarction. British Heart Journal 1980;43(4):463-9. - PMC - PubMed
Sato 1992 {published data only}
    1. Sato I, Nishida M, Okita K, Nishijima H, Kojima S, Matsumura N, et al. Beneficial effect of stopping smoking on future cardiac events in male smokers with previous myocardial infarction. Japanese Circulation Journal 1992;56(3):217-22. - PubMed
Shah 2010 {published data only}
    1. Shah AM, Pfeffer MA, Hartley HL, Moye LA, Gersh BJ, Rutherford JD, et al. Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction. American Journal of Cardiology 2010;106(7):911-6. - PubMed
Snaterse 2015 {published data only}
    1. Snaterse M, Scholte Op RW, Dobber J, Minneboo M, Ter Riet G, Jorstad HT, et al. Smoking cessation after an acute coronary syndrome: immediate quitters are successful quitters. Netherlands Heart Journal 2015;23(12):600-7. - PMC - PubMed
Sochor 2015 {published data only}
    1. Sochor O, Lennon RJ, Rodriguez-Escudero JP, Bresnahan JF, Croghan A, Somers VK, et al. Trends and predictors of smoking cessation after percutaneous coronary intervention (from Olmsted County, Minnesota, 1999 to 2010). American Journal of Cardiology 2015;115(4):405-10. - PubMed
Sparrow 1978 {published data only}
    1. Sparrow D, Dawber TR. The influence of cigarette smoking on prognosis after a first myocardial infarction. A report from the Framingham study. Journal of Chronic Diseases 1978;31(6-7):425-32. - PubMed
Sun 2011 {published data only}
    1. Sun H, Hu S, Zheng Z, Hou J. Impact of smoking and smoking cessation on long-term outcome of patients after coronary artery bypass grafting. Zhonghua Xin Xue Guan Bing Za Zhi 2011;39(9):825-9. - PubMed
Taira 2000 {published data only}
    1. Taira DA, Seto TB, Ho KK, Krumholz HM, Cutlip DE, Berezin R, et al. Impact of smoking on health-related quality of life after percutaneous coronary revascularization. Circulation 2000;102(12):1369-74. - PubMed
Toefler 1993 {unpublished data only}
    1. Toefler GH, Muller JE, Stone PH, Davies G, Davis VG, Braunwald E. Comparison of long-term outcome after acute myocardial infarction in patients never graduated from high school with that in more educated patients. Multicenter Investigation of the Limitation of Infarct Size (MILIS). American Journal of Cardiolology 1993;71:103-5. - PubMed
Van Den Berg 2019 {published data only}
    1. Van den Berg MJ, Van der Graaf Y, Deckers JW, De Kanter W, Algra A, Kappelle LJ, et al. Smoking cessation and risk of recurrent cardiovascular events and mortality after a first manifestation of arterial disease. American Heart Journal 2019;213(0370465):112-22. - PubMed
van Domburg 2008 {published data only}
    1. Van Domburg RT, Op Reimer WS, Hoeks SE, Kappetein AP, Bogers A. Three life-years gained from smoking cessation after coronary artery bypass surgery: a 30-year follow-up study. American Heart Journal 2008;156(3):473-6. - PubMed
Vlietstra 1986 {published data only}
    1. Vlietstra RE, Kronmal RA, Oberman A, Frye RL, Killip T. Effect of cigarette smoking on survival of patients with angiographically documented coronary artery disease. Report from the CASS registry. JAMA 1986;255(8):1023-7. - PubMed
Voors 1996 {published data only}
    1. Voors AA, Van Brussel BL, Plokker HW, Ernst SM, Ernst NM, Koomen EM, et al. Smoking and cardiac events after venous coronary bypass surgery. A 15-year follow-up study. Circulation 1996;93(1):42-7. - PubMed
Wang 2021 {published data only}
    1. Wang Y, Tse LA, Li G, Yin L, Chen T, Zhao Y, et al. The role of diabetes mellitus as an effect modifier of the association between smoking cessation and its clinical prognoses: an observational cohort study. Angiology 2021;72(1):78-85. - PubMed
Weng 1990 {published data only}
    1. Weng XZ, He J, Su M. Long-term prognosis after recovery from acute myocardial infarction. Zhonghua Nei Ke Za Zhi 1990;29(7):412-45. - PubMed
Wiggers 2006 {published data only}
    1. Wiggers LC, Oort FJ, Peters RJ, Legemate DA, De Haes HC, Smets EM. Smoking cessation may not improve quality of life in atherosclerotic patients. Nicotine & Tobacco Research 2006;8(4):581-9. - PubMed
Wilhelmsen 1975 {published data only}
    1. Wilhelmsen L, Sanne H, Elmfeldt D, Grimby G, Tibblin G, Wedel H. A controlled trial of physical training after myocardial infarction. Effects on risk factors, nonfatal reinfarction, and death. Preventive Medicine 1975;4(4):491-508. - PubMed
Wilhelmsson 1975 {published data only}
    1. Wilhelmsson C, Vedin JA, Elmfeldt D, Tibblin G, Wilhelmsen L. Smoking and myocardial infarction. Lancet 1975;1(7904):415-20. - PubMed
Xue 2017 {published data only}
    1. Xue C, Bian L, Xie YS, Yin ZF, Xu ZJ, Chen QZ, et al. Impact of smoking on health-related quality of Life after percutaneous coronary intervention treated with drug-eluting stents: a longitudinal observational study. Health and Quality of Life Outcomes 2017;15(1):1. - PMC - PubMed
Yudi 2017 {published data only}
    1. Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Kalten K, Brennan AL, et al. The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry. BMJ Open 2017;7(10):e016874. - PMC - PubMed
Zhang 2013 {published data only}
    1. Zhang DD, Eisenberg M, Grandi SM, Joseph L, Pilote L, Filion K. Bupropion, smoking cessation, and health-related quality of life following an acute myocardial infarction. Canadian Journal of Cardiology 2013;29(10 Suppl 1):S290-1. - PubMed
Zhu 2009 {published data only}
    1. Zhu ZY, Gao CU, Niu ZM, Chen Y, Huang KJ, Liu YH, et al. Association between smoking status at follow-up and clinical outcomes in patients undergoing successful percutaneous coronary intervention. Zhonghua Xin Xue Guan Bing Za Zhi 2009;37(9):777-80. - PubMed

References to studies excluded from this review

Beatty 2015 {published data only}
    1. Beatty AL, Ku IA, Bibbins-Domingo K, Christenson RH, DeFilippi CR, Ganz P, et al. Traditional risk factors versus biomarkers for prediction of secondary events in patients with stable coronary heart disease: from the heart and soul study. Journal of the American Heart Association 2015;4(7):e001646. - PMC - PubMed
Dornelas 2000 {published data only}
    1. Dornelas EA, Sampson RA, Gray JF, Waters D, Thompson PD. A randomized controlled trial of smoking cessation counseling after myocardial infarction. Preventive Medicine 2000;30(4):261-8. - PubMed
Goldenberg 2003 {published data only}
    1. Goldenberg I, Jonas M, Tenenbaum A, Matetzky S, Shotan A, Boyko V, et al. Current smoking, smoking cessation, and the risk of sudden cardiac death in patients with coronary artery disease. Archives of Internal Medicine 2003;163(19):2301-5. - PubMed
Houston 2005 {published data only}
    1. Houston TK, Allison JJ, Person S, Kovac S, Williams OD, Kiefe CI. Post-myocardial infarction smoking cessation counseling: associations with immediate and late mortality in older Medicare patients. American Journal of Medicine 2005;118(3):269-75. - PubMed
Ma 2016 {published data only}
    1. Ma J, Wang X, Gao M, Ding Y, Guan Y. Effect of smoking status on coronary artery disease among Chinese post-menopausal women. Internal and Emergency Medicine 2016;11(4):529-35. - PubMed
Qiao 2000 {published data only}
    1. Qiao Q, Tervahauta M, Nissinen A, Tuomilehto J. Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men. European Heart Journal 2000;21(19):1621-6. - PubMed
Rocha 2017 {published data only}
    1. Rocha V, Guerra MP, Lemos MS, Maciel J, Williams GC. Smoking abstinence twelve months after an acute coronary syndrome. Spanish Journal of Psychology 2017;20(101095192):E63. - PubMed
Schmitz 1999 {published data only}
    1. Schmitz JM, Spiga R, Rhoades HM, Fuentes F, Grabowski J. Smoking cessation in women with cardiac risk: a comparative study of two theoretically based therapies. Nicotine & Tobacco Research 1999;1(1):87-94. - PubMed
Steele 2017 {published data only}
    1. Steele L, Lloyd A, Fotheringham J, Sultan A, Iqbal J, Grech ED. A retrospective cohort study of the association between smoking and mortality after acute ST-segment elevation myocardial infarction. Postgraduate Medical Journal 2017;93(1102):489-93. - PubMed
Van Spall 2007 {published data only}
    1. Van Spall HG, Chong A, Tu JV. Inpatient smoking-cessation counseling and all-cause mortality in patients with acute myocardial infarction. American Heart Journal 2007;154(2):213-20. - PubMed

Additional references

Banks 2019
    1. Banks E, Joshy G, Korda RJ, Stavreski B, Soga K, Egger S, et al. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Medicine 2019;17(1):1-18. [DOI: 10.1186/s12916-019-1351-4] - DOI - PMC - PubMed
Benjamin 2019
    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics – 2019 update: a report from the American Heart Association. Circulation 2019;139(10):e56-528. - PubMed
Brugts 2009
    1. Brugts JJ, Ninomiya T, Boersma E, Remme WJ, Bertrand M, Ferrari R, et al. The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. European Heart Journal 2009;30(11):1385-94. - PubMed
Cahill 2013
    1. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No: CD009329. [DOI: 10.1002/14651858.CD009329.pub2] - DOI - PMC - PubMed
Carter 2015
    1. Carter BD, Abnet CC, Feskanich D, Freedman ND, Hartge P, Lewis CE, et al. Smoking and mortality — beyond established causes. New England Journal of Medicine 2015;372(7):631-40. - PubMed
Celermajer 1993
    1. Celermajer DS, Sorensen KE, Georgakopoulos D, Bull C, Thomas O, Robinson J, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993;88(5):2149-55. - PubMed
Choi 2013
    1. Choi YJ, Park JS, Kim U, Lee SH, Son JW, Shin DG, et al. Changes in smoking behavior and adherence to preventive guidelines among smokers after a heart attack. Journal of Geriatric Cardiology 2013;10(2):146-50. - PMC - PubMed
Cohen 2013
    1. Cohen J. Statistical power analysis for the behavioral sciences. Routledge, 2013.
Davignon 2004
    1. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation 2004;109(23 Suppl 1):Iii27-32. - PubMed
Deeks 2021
    1. Deeks JJ, Higgins JP, Altman DG editor(s). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Delgado 2020
    1. Delgado GE, Krämer BK, Siekmeier R, Yazdani B, März W, Leipe J, et al. Influence of smoking and smoking cessation on biomarkers of endothelial function and their association with mortality. Atherosclerosis 2020;292:52-9. - PubMed
Dorresteijn 2013
    1. Dorresteijn JA, Visseren FL, Wassink AM, Gondrie MJ, Steyerberg EW, Ridker PM, et al. Development and validation of a prediction rule for recurrent vascular events based on a cohort study of patients with arterial disease: the SMART risk score. Heart 2013;99(12):866-72. - PubMed
Farley 2017
    1. Farley A, Koshiaris C, Oke J, Ryan R, Szatkowski L, Stevens R, et al. Physician support of smoking cessation after diagnosis of lung, bladder, or upper aerodigestive tract cancer. Annals of Family Medicine 2017;15(5):443-50. - PMC - PubMed
Follmann 1992
    1. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. Journal of Clinical Epidemiology 1992;45(7):769-73. - PubMed
Gakidou 2017
    1. Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 – 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390(10100):1345-422. - PMC - PubMed
Gottlieb 1998
    1. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. New England Journal of Medicine 1998;339(8):489-97. - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed 25 January 2021. Hamilton (ON): McMaster University (developed by Evidence Prime). Available at gradepro.org.
Hartmann‐Boyce 2021
    1. Hartmann-Boyce J, Livingstone-Banks J, Ordonez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, et al. Behavioural interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No: CD013229. [DOI: 10.1002/14651858.CD013229.pub2] - DOI - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60. - PMC - PubMed
Higgins 2021
    1. Higgins JP, Li T, Deeks JJ editor(s). Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.
Hummel 2018
    1. Hummel K, Nagelhout GE, Fong GT, Vardavas CI, Papadakis S, Herbeć A, et al. Quitting activity and use of cessation assistance reported by smokers in eight European countries: findings from the EUREST-PLUS ITC Europe surveys. Tobacco Induced Diseases 2018;16:A6. [DOI: 10.18332/tid/98912] - DOI - PMC - PubMed
IARC 2007
    1. Tobacco Control: Reversal of Risk After Quitting Smoking, IARC Handbooks of Cancer Prevention. publications.iarc.fr/Book-And-Report-Series/Iarc-Handbooks-Of-Cancer-Pre... (accessed prior to July 2022).
Johnson 2010
    1. Johnson HM, Gossett LK, Piper ME, Aeschlimann SE, Korcarz CE, Baker TB, et al. Effects of smoking and smoking cessation on endothelial function: 1-year outcomes from a randomized clinical trial. Journal of the American College of Cardiology 2010;55(18):1988-95. - PMC - PubMed
Kendir 2018
    1. Kendir C, Van Den Akker M, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity: a cross-sectional study in the Netherlands. European Journal of General Practice 2018;24(1):45-50. - PMC - PubMed
Kotseva 2016
    1. Kotseva K, Wood D, De Bacquer D, De Backer G, Rydén L, Jennings C, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. European Journal of Preventive Cardiology 2016;23(6):636-48. - PubMed
Lim 2017
    1. Lim YK, Shin DW, Kim HS, Yun JM, Shin JH, Lee HJ, et al. Persistent smoking after a cardiovascular event: a nationwide retrospective study in Korea. PloS One 2017;12(10):e0186872. - PMC - PubMed
Matsuzawa 2015
    1. Matsuzawa Y, Guddeti RR, Kwon T-G, Lerman LO, Lerman A. Secondary prevention strategy of cardiovascular disease using endothelial function testing. Circulation Journal 2015;79(4):685-94. - PubMed
McGuinness 2021
    1. McGuinness LA, Higgins JP. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods 2021;12(1):55-61. - PubMed
Mons 2015
    1. Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, et al. 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. - PMC - PubMed
Morita 2005
    1. Morita H, Ikeda H, Haramaki N, Eguchi H, Imaizumi T. Only two-week smoking cessation improves platelet aggregability and intraplatelet redox imbalance of long-term smokers. Journal of the American College of Cardiology 2005;45(4):589-94. - PubMed
Nagareddy 2013
    1. Nagareddy P, Smyth SS. Inflammation and thrombosis in cardiovascular disease. Current Opinion in Hematology 2013;20(5):457-63. - PMC - PubMed
Page 2021
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. [DOI: 10.1136/bmj.n71] - DOI - PMC - PubMed
Pamukcu 2011
    1. Pamukcu B, Oflaz H, Onur I, Cimen A, Nisanci Y. Effect of cigarette smoking on platelet aggregation. Clinical and Applied Thrombosis/Hemostasis 2011;17(6):E175-80. - PubMed
Rallidis 2005
    1. Rallidis LS, Hamodraka ES, Foulidis VO, Pavlakis GP. Persistent smokers after myocardial infarction: a group that requires special attention. International Journal of Cardiology 2005;100(2):241-5. - PubMed
RevMan Web 2022 [Computer program]
    1. Review Manager Web (RevMan Web). Version 4.11.0. The Cochrane Collaboration, 2022. Available at revman.cochrane.org.
Roth 2020
    1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 Study. Journal of the American College of Cardiology 2020;76(25):2982-3021. - PMC - PubMed
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editor(s). Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach (updated October 2013). GRADE Working Group, 2013. Available from gdt.guidelinedevelopment.org/app/handbook/handbook.html.
Smith 2011
    1. Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update. Circulation 2011;124(22):2458-73. - PubMed
Sterne 2016
    1. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919. - PMC - PubMed
Thomas 2021
    1. Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, et al. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technology Assessment 2021;25:59. - PubMed
USDHHS 2010
    1. How tobacco smoke causes disease – the biology and behavioral basis for smoking-attributable disease: a report of the Surgeon General. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010. - PubMed
USDHHS 2020
    1. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Smoking cessation: a report of the Surgeon General. www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/2020-cessati... (accessed prior to July 2022).
Wilkins 2017
    1. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R, et al. European cardiovascular disease statistics 2017. Available at researchportal.bath.ac.uk/en/publications/european-cardiovascular-diseas... 2017.
Wilt 2004
    1. Wilt TJ, Bloomfield HE, MacDonald R, Nelson D, Rutks I, Ho M, et al. Effectiveness of statin therapy in adults with coronary heart disease. Archives of Internal Medicine 2004;164(13):1427-36. - PubMed
Yusuf 2011
    1. Yusuf S, Islam S, Chow CK, Rangarajan S, Dagenais G, Diaz R, et al. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011;378(9798):1231-43. - PubMed

References to other published versions of this review

Critchley 2003a
    1. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No: CD003041. [DOI: 10.1002/14651858.CD003041.pub2] - DOI - PubMed
Critchley 2003b
    1. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003;290(1):86-97. - PubMed
Wu 2021
    1. Wu AD, Hartmann-Boyce J, Lindson N, Aveyard P. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2021, Issue 4. Art. No: CD014936. [DOI: 10.1002/14651858.CD014936] - DOI - PMC - PubMed

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