Smoking-cessation counseling crucial for patients with PAD
LAS VEGAS — Smoking is a major risk factor for peripheral artery disease, and patients are more likely to quit smoking if their doctors counsel them.
The health benefits of quitting smoking are numerous, Suman Wasan, MD, MS, vascular medicine specialist at the Thomas Whitsett Oklahoma University Vascular Clinic, said during a presentation at VIVA 18.
“At 1 year, excess risk for CHD decreases to half that of people who are still smoking. At 5 years, risk for stroke is reduced to that of people who never smoked. At 10 years, the rate of lung cancer drops to half that of continuing smokers. After 15 years, the risk for CHD is similar to people who have never smoked,” Wasan said.
Unfortunately, many smokers continue to smoke after becoming aware of these facts because many fear side effects from nicotine withdrawal, she said.
Therefore, she said, it may be necessary to prescribe smoking-cessation medications that can mitigate withdrawal symptoms. Such medications include nicotine gums, lozenges, patches, nasal sprays and inhalers, as well as two medications that work on the brain’s nicotine receptors, bupropion and varenicline (Chantix, Pfizer).
Of those, varenicline has the highest 6-month quit rates, she said. The OR for smoking cessation after treatment with varenicline vs. placebo is 2.9, compared with 1.7 to 2.7 for other smoking-cessation medications.
Broad recommendation of e-cigarettes for smoking cessation is not yet recommended, as there is evidence that these devices reduce the frequency of cigarette smoking, but little evidence that they are an effective bridge to quitting, Wasan said.
When a physician intervention is performed, the odds of quitting are 2.2-fold higher than if there is no professional intervention, she said, noting the figure is 1.7-fold higher if the intervention is by a nonphysician clinician and only 1.1-fold higher if the patient relies on self-help material alone.
When meeting with a patient with PAD for the first time, “you have to ask about tobacco use, advise tobacco users to quit and refer them to other resources,” she said.
During a panel discussion, J. Michael Bacharach, MD, MPH, section head of vascular medicine and peripheral vascular intervention at North Central Heart Institute and Avera Heart Hospital, Sioux Falls, South Dakota, said a good tactic is to ask the patient when he or she smokes their first cigarette of the day.
“If they light a cigarette as soon as they get out of bed before they even get to the bathroom, they are so addicted to nicotine that you will probably never get them to quit,” he said. “However, if they don’t light one until they have their breakfast, then they may be smoking out of habit, and it may be easier to get them to quit.” – by Erik Swain
Wasan S. Novel Methods for Smoking Cessation. PharmacoRx: Pharmacotherapy in PAD. Presented at: VIVA 18; Nov. 5-8, 2018; Las Vegas.
Disclosure: Wasan reports she received honoraria from Tactile Systems Inc., consulted for Janssen and received research funding from Diagnostica Stago. Bacharach reports he received honoraria from Boston Scientific, Bristol-Myers Squibb, Cook Medical and W.L. Gore and Associates, has consulted for W.L. Gore and Associates and has received research funding from AstraZeneca, Bayer, Bolton Medical, Endologix, St. Jude Medical, TriVascular, Veryan/Novate and W.L. Gore and Associates.