Boston, MA -- The rate of heart attacks is continuing to increase among individuals younger than 50 years old. While the protective effects of quitting smoking are well documented among older individuals who have experienced a heart attack, the benefits have not been well studied among younger heart attack survivors. In a study published this week in JAMA Network Open, investigators from Brigham and Women's Hospital share results from a study of the association between quitting smoking and survival among young adults who have survived a heart attack. Based on a retrospective analysis of data from the Partners YOUNG-MI registry, the team found that about half of individuals who experienced a heart attack before age 50 were active smokers. Among those who quit within a year of their first heart attack, rates of death from heart disease or any cause of death were more than 70 percent lower than among those who did not quit.
"These results are definitive: among young people who have had a heart attack, quitting smoking is associated with a substantial benefit," said corresponding author Ron Blankstein, MD, of the Division of Cardiovascular Medicine at the Brigham. "In cardiology, we are always looking for ways to reduce the risk of cardiovascular events, be it in the form of new medications or other interventions. Our findings show the dramatic magnitude of the effect that quitting smoking can have for young adults. But, unfortunately, we also found that most young patients kept on smoking after their heart attack, reinforcing that there is a major opportunity for improvement. Now the big question is, how can we as a health care system help patients quit?"
The Partners Young-MI registry holds data from patients younger than 50 who experienced a heart attack and were seen at Brigham and Women's Hospital and Massachusetts General Hospital between January 2000 and April 2016. The registry includes 2,072 individuals. Among them, 1,088 were smokers at the time of their heart attack. Among individuals for whom data on smoking status at one year was available, 343 patients (38 percent) had quit smoking and 567 (62 percent) continued to smoke. Both groups were comparable in terms of age and race.
Over the next ten years, 75 of the persistent smokers (13.2 percent) died compared to 14 (4.1 percent) of those who had quit within a year of their first heart attack. Of the persistent smokers, 30 died of a heart attack or other cardiovascular event (5.3 percent) compared to six (1.7 percent) of those who had quit smoking.
The authors note that given the study's retrospective design, unmeasured factors such as other healthy lifestyle choices may be at play. In addition, the study design did not evaluate long-term smoking status, and thus did not account for those who stopped smoking after one year but then relapsed.
"These limitations notwithstanding, our findings reinforce the critical importance of smoking cessation, especially among those who experience a heart attack at a young age," said Blankstein. "Looking at the trajectories of young patients who quit smoking versus those who don't paints a clear picture of the magnitude of risk compared to the benefit of smoking cessation."
Co-authors of this paper are supported by a T32 postdoctoral training grant from the NHLBI
(T32 HL094301, T32 HL007604). Blankstein reported receiving research support from Amgen Inc and Astellas Inc. A full list of conflict of interest disclosures can be found in the paper.
Paper cited: Blery, DW et al. "Association of Smoking Cessation and Survival Among Young Adults With Myocardial Infarction in the Partners YOUNG-MI Registry" JAMA Network Open DOI:10.1001/jamanetworkopen.2020.9649