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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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JAMA => The War Against Tobacco: 50 Years and Counting

JAMA => The War Against Tobacco: 50 Years and Counting | Heart and Vascular Health | Scoop.it

JAMA theme issue on tobacco control.  Epidemiology, original reserach and the status of e-cigarettes and strategies for quitting cigarettes is reviewed.  It's been 50 years since the Surgeon General's report. 

Seth Bilazarian, MD's insight:

The cover collage is great.  How far we've come, but not all the way there.  The advertisement of a physician recommending smoking at the top left with highlights of the Surgeon general's report and other news highlights over the last 50 years.

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Teen smoking rates stuck at 1 in 12.

Teen smoking rates stuck at 1 in 12. | Heart and Vascular Health | Scoop.it
For years, health officials watched with satisfaction as rates of teen smoking in New York City plummeted, far outpacing the national average. In 2007, the rate dipped to 8.5%. Then it stopped falling.
Seth Bilazarian, MD's insight:

To be sure, the 8.5% is still a dramatic improvement from 15 years ago, when nearly a quarter of the city's high school-age students smoked, according to data from the Department of Health and Mental Hygiene.

The stagnation mirrors a national trend, experts said, though the city's numbers remain well below the national teen-smoking average of 18.1% and even the state average of 12.5%.

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FDA Drug Safety Communication: Safety review update of Chantix (varenicline) and risk of cardiovascular adverse events

FDA Drug Safety Communication: Safety review update of Chantix (varenicline) and risk of cardiovascular adverse events | Heart and Vascular Health | Scoop.it
FDA is informing the public about a meta-analysis of trials that compared patients who received the smoking cessation drug Chantix (varenicline). FDA first notified the public about a possible increased risk of cardiovascular adverse events with Chantix in its June 2011 Drug Safety Communication (DSC).
The meta-analysis showed higher rates of composite outcomes on Chantix. Although these findings were not statistically significant, they were consistent. It should be noted that the incidence of cardiovascular mortality (Chantix 0.05% [2/4190] vs. placebo 0.07% [2/2812]) and all-cause mortality (Chantix 0.14% [6/4190] vs. placebo 0.25% [7/2812]) was lower in the Chantix group compared to the placebo group, although this finding was also not statistically significant.
Seth Bilazarian, MD's insight:

Balancing the risk of ongoing smoking vs. these tiny differences during 6 months of treatment with Chantix will have to be made individulally by patients and their doctors.  Ideally patients quit smoking without any added drugs but for many patients addicted to smoking this is not possible.

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Absolute Risk of Tobacco Deaths: One in Two Smokers Will Be Killed by Smoking

Absolute Risk of Tobacco Deaths: One in Two Smokers Will Be Killed by Smoking | Heart and Vascular Health | Scoop.it
If you have help 2 smokers quit, you have saved (at least) 1 life The acronym “AWARD” is a guide:  (1) Ask about smoking.  (2) Warn smoking patients by saying “If you continue to smoke, your chance of dying from smoking-induced diseases (such as cancer, heart diseases, stroke, and respiratory and many other serious diseases) is 50% (67% for the very young; 40% for the very old).”  (3) Advise: “If you quit now, your risk will be greatly reduced (by 25% at old age, and by much more before age 40 years).” This will take about 10 seconds.  (4) Refer to a cessation clinic or hotline (5) Do it again until they quit
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Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months

Electronic cigarettes for smoking cessation: Only work 7.3% at 6 months | Heart and Vascular Health | Scoop.it

Electronic cigarettes (e-cigarettes) can deliver nicotine and mitigate tobacco withdrawal and are used by many smokers to assist quit attempts. We investigated whether e-cigarettes are more effective than nicotine patches at helping smokers to quit.657 people were randomised (289 to nicotine e-cigarettes, 295 to patches, and 73 to placebo e-cigarettes) and were included in the intention-to-treat analysis. At 6 months, verified abstinence was 7·3% (21 of 289) with nicotine e-cigarettes, 5·8% (17 of 295) with patches, and 4·1% (three of 73) with placebo e-cigarettes (risk difference for nicotine e-cigarette vs patches 1·51 [95% CI −2·49 to 5·51]; for nicotine e-cigarettes vs placebo e-cigarettes 3·16 [95% CI −2·29 to 8·61]). Achievement of abstinence was substantially lower than we anticipated.. We identified no significant differences in adverse events, with 137 events in the nicotine e-cigarettes group, 119 events in the patches group, and 36 events in the placebo e-cigarettes group. We noted no evidence of an association between adverse events and study product.E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events. Uncertainty exists about the place of e-cigarettes in tobacco control, and more research is urgently needed to clearly establish their overall benefits and harms at both individual and population levels.

Seth Bilazarian, MD's insight:

The lack of success using e-cigarettes to quit smoking is consistent with the experience of my patients.  The 7.3% rate is low and not different from nicotine patches. For my patients, I fear that the well intentioned switch to e-cigarettes, with plans to quit, results in permanent e-cigarette use.  We just don't have any safety data about the use of these devices that are not regulated for quality or purity by FDA and largely made outside the US.  This study was small and there was a trend toward more adverse events with e-cigs.  The best I can tell my patients is that short term use as a strategy to quit smoking is probably safe. My blog on the topic:  http://www.medscape.com/viewarticle/801964?t=1

 

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Important facts about quitting smoking and weight gain

Important facts about quitting smoking and weight gain | Heart and Vascular Health | Scoop.it

Quitting smoking is arguably the most important step that smokers can take to improve their health and prevent premature death. Smoking cessation greatly reduces the risk of multiple types of cancer, cardiovascular disease (CVD), and chronic obstructive pulmonary disease (COPD) complications and has other health benefits such as improved wound healing and reduced risk of hip fractures and cataracts.

Patients should not be concerned about the health effects of cessation-related weight gain. About 50% of female smokers and about 25% of male smokers are “weight concerned,” which may discourage quit attempts and quitting success. Even though no treatments have been shown to reliably prevent cessation-related weight gain, exercise regimens may be beneficial, and use of nicotine replacement medications can suppress weight gain during their use.

The most important message of two articles in the 3/13/2013 JAMA is that every smoker should be encouraged to quit smoking and given support to do so.

Seth Bilazarian, MD's insight:

Patients worry about weight gain with smoking cessation.  It may be an excuse to not want to tackle this tough addicition.

Weight gain is a frequent side effect when people quit smoking.  But the health benefits of stopping smoking far outweigh the cardiovascular hazard of weight gain.

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Is Quitting Smoking Harder for Women?

Is Quitting Smoking Harder for Women? | Heart and Vascular Health | Scoop.it

THE BOTTOM LINE According to the strongest data, men do not have an easier time giving up smoking than women.

 

Conventional wisdom says it is harder to quit for women, but the largest study of the claim to date finds that there is little difference in successful cessation rates among men and women.

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