Smoking cessation following admission to a coronary care unit Coronary Heart Disease Risk Reduction Intervention Among Overweight Smokers with a Psychotic Disorder: Pilot Trial The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden. EFFECT OF DIET AND SMOKING INTERVENTION ON THE INCIDENCE OF CORONARY HEART DISEASE: Report from the Oslo Study Group of a Randomised Trial in Healthy Men Does smoking cessation improve Quality of Life in patients with coronary heart disease? Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease Smoking, Smoking Cessation, and Risk of Sudden Cardiac Death in Women Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Quitting and restarting smoking: cohort study of patients with angina in primary care An education program for risk factor management after an acute coronary syndrome: a randomized clinical trial. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study Smoking cessation initiated during hospital stay for patients with coronary artery disease: a randomized controlled trial Predictors of smoking cessation in patients admitted for acute coronary heart disease A novel programme to evaluate and communicate 10-year risk of CHD reduces predicted risk and improves patients' modifiable risk factor profile Assessment of coronary heart disease risk, I. A postal inquiry among primary care physicians.
Objective : To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting . Design : Prospect i ve observational study in which smokers admitted to a coronary care unit ( CCU ) were followed for one year after hospital discharge to determine subsequent smoking behavior . Setting : Coronary care unit of a teaching hospital . Patients : Preadmission  smoking status was assessed in all 828 patients admitted to the CCU during one year . The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months . Intervention : None . Measurements and main results : Six months after discharge , 32 % of survivors were not smoking ; the rate of sustained cessation at one year was 25 % . Smokers with a new diagnosis of coronary heart disease ( CHD ) made during hospitalization had the highest cessation rate ( 53 % vs. 31 % , p=0.01 ) . On multivariate analysis , smoking cessation was more likely if patients were discharged with a diagnosis of CHD , had no prior history of CHD , were lighter smokers ( < 1 pack/day ) , and had congestive heart failure during hospitalization . Among smokers admitted because of suspected myocardial infa rct ion ( MI ) , cessation was more likely if the diagnosis was CHD than if it was noncoronary ( 37 % vs. 19 % , p<0.05 ) , but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency . Conclusion : Hospitalization in a CCU is a stimulus to long-term smoking cessation , especially for lighter smokers and those with a new diagnosis of CHD . Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention . Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality , even when quitting occurs after the onset of CHD Objective : The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing ( i ) coronary heart disease ( CHD ) risk ; ( ii ) smoking ; and ( iii ) weight among smokers with psychosis . Secondary dependent variables included physical activity , unhealthy eating , substance use , psychiatric symptomatology , treatment retention , general functioning , and quality of life . Method : This was a feasibility study utilizing a pre – post-treatment design with  no control group ( n=43 ) . All participants provided written informed consent and were assessed before treatment and again a mean of 19.6weeks later . The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy , in addition to treatment as usual . Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessment s. Results : The intervention was associated with significant reductions in CHD risk scores , smoking and weight . A significant improvement was also reported in level of moderate physical activity , and a small change in the unhealthy eating index was reported . No improvement in biological measures ( cholesterol and blood pressure ) was evident . Conclusions : A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term . A r and omized controlled trial replicating and extending these findings is warranted The impact of smoking cessation on coronary heart disease ( CHD ) and lung cancer was assessed after 10.5 years of follow-up in the 12,866 men in the Multiple Risk Factor Intervention Trial ( MRFIT ) . Those men who died of lung cancer ( n = 119 ) were either cigarette smokers at entry or ex-smokers ; no lung cancer deaths occurred among the 1,859 men who reported never smoking cigarettes . The risk of lung cancer for smokers , adjusted for selected baseline variables using a Cox proportional hazards model , increased as the number of cigarettes smoked increased ( B = 0.0203 , SE = 0.0076 ) . There was not the same grade d response for CHD among smokers at entry . The risk of CHD death was greater among smokers than nonsmokers ( RR = 1.57 ) ( B = -0.0034 , S.E. = 0.0048 ) . After one year of cessation , the relative risk of dying of CHD for the quitters as compared to non-quitters ( RR = 0.63 ) was significantly lower even after adjusting for baseline differences and changes in other risk factors . The relative risk for smokers who quit for at least the first three years of the trial was even lower compared to non-quitters ( RR = 0.38 ) . However , the relative risk for lung cancer for quitters versus non-quitters was close to 1 both for quitters at 12 months and at three years . These data support the benefits of cessation in relation to CHD and are consistent with other epidemiologic studies which suggest that the lag time for a beneficial effect of smoking cessation on lung cancer may be as long as 20 years abstract Objective To determine whether a nurse led smoking cessation intervention affects smoking cessation rates in patients admitted for coronary heart disease . Design R and omised controlled trial . Setting Cardiac ward of a general hospital , Norway . Participants 240 smokers aged under 76 years admitted for myocardial infa rct ion , unstable angina , or cardiac bypass surgery . 118 were r and omly assigned to the intervention and 122 to usual care  ( control group ) . Intervention The intervention was based on a booklet and focused on fear arousal and prevention of relapses .  The intervention was delivered by cardiac nurses without special training . The intervention was initiated in hospital , and the participants were contacted regularly for at least five months . Main outcome measure Smoking cessation rates at 12 months determined by self report and biochemical verification . Results 12 months after admission to hospital , 57 % ( n = 57/100)of patients in the intervention group and 37 % ( n = 44/118 ) in the control group had quit smoking ( absolute risk reduction 20 % , 95 % confidence interval 6 % to 33 % ) . The number needed to treat to get one additional person who would quit was 5 ( 3 to 16 ) . Assuming all dropouts relapsed at 12 months , the smoking cessation rates were 50 % in the intervention group and 37 % in the control group ( absolute risk reduction 13 % , 0 % to 26 % ) . Conclusion A smoking cessation programme delivered by cardiac nurses without special training , significantly reduced smoking rates in patients 12 months after admission to hospital for coronary heart disease STUDY OBJECTIVE : To investigate differences between smokers and non-smokers in health behaviour , cardiovascular risk factors , coronary heart disease ( CHD ) risks , health knowledge , health attitudes , and compliance with a CHD prevention programme . DESIGN : Differences between smokers and non-smokers were studied via medical examinations , question naires , physical exercise activity logs , and food record sheets . Data were analysed using univariate and multivariate analyses . The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate . SETTING : The Karolinska Hospital , Stockholm , and Sollentuna Primary Health Centre , Sollentuna , Sweden . PARTICIPANTS : The analyses were based on 158 healthy smoking and non-smoking men aged 35 - 60 years with raised cardiovascular risk factors who enrolled in controlled , r and omised six month diet and exercise programmes .  MAIN RESULTS : Discriminant analysis suggested that smokers , compared with non-smokers , were characterised by a higher alcohol energy percent , lower HDL cholesterol concentration , lower systolic blood pressure , and a higher plasminogen activator inhibitor-1 ( PAI-1 ) value . Knowledge of the risk factors for CHD was not a discriminating factor . Both smokers and non-smokers increased the exercise taken , improved their diet , and lowered their CHD risk . Before , as well as after the intervention , smokers had a higher CHD risk than non-smokers . CONCLUSIONS : The best CHD prevention action that could be taken by smokers would of course be to quit smoking . Those who can not stop should be encouraged to improve their diet and increase the amount of  physical exercise  they take in order to reduce the health hazards of their smoking behaviour 16 202 men , aged 40 - 49 years , were screened for coronary risk factors , Of these , 1232 healthy , normotensive men at high risk of coronary heart disease ( CHD ) were selected for a 5-year r and omised trial to show whether lowering of serum lipids and cessation of smoking could reduce the incidence of CHD . Men were admitted to the trial if they had serum cholesterol levels of 7.5 - 9.8 mmol/l ( 290 - 380 ) mg/dl ) , coronary risk scores ( based on cholesterol levels , smoking habits , and blood pressure ) in the upper quartile of the distribution , and systolic blood pressures below 150 mm Hg ( mean of two measurements ) . The men in the intervention group were recommended to lower their blood lipids by change of diet and to stop smoking .  Mean serum cholesterol concentrations were approximately 13 % lower in the intervention group than in the control group during the trial ( based on the difference between the mean of 3 prer and omisation values and the mean of yearly values during the trial ) . Mean fasting serum triglycerides fell by 20 % in the intervention group compared with controls . 80 % of the men in both groups smoked tobacco daily at the start of the study . The mean tobacco consumption per man decreased by 45 % more in the intervention group than in the control group . However , only 25 % of the smokers in the intervention group completely stopped smoking compared with 17 % in the control group . Diagnosis of events of cardiovascular disease during the study was made blindly according to predefined criteria by two cardiologists not involved in the study . At the end of the observation period the incidence of myocardial infa rct ion ( fatal and non-fatal ) and sudden death was 47 % lower in the intervention group than in the controls ( p = 0.028 , two-tailed log rank test ) . When the incidence of strokes was added , the difference between the groups was still significant . It is concluded that in healthy middle-aged men at high risk of CHD advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of myocardial infa rct ion and sudden death . Statistical analysis , by Cox 's proportional hazards model shows that the reduction in incidence in the intervention group is correlated with the reduction in total cholesterol and to a lesser extent with smoking reduction Objective . To evaluate whether smoking cessation after a coronary event improves quality of life , and to assess whether quality of life is a predictor of smoking cessation . Design . Health-related quality of life  at baseline and at 12 months follow up were measured in a r and omised smoking cessation trial of 240 smokers aged under 76 years admitted for myocardial infa rct ion , unstable angina or coronary bypass surgery . At 12 months follow up 101 had managed to give up smoking ( quitters ) , and 117 were smokers ( sustained smokers ) . Results . The quitters and sustained smokers had similar improvements in all quality of life domains from baseline to 12 months follow up . Further , after adjustment for differences in baseline characteristics , the quality of life was not significantly different in the quitters compared to the sustained smokers neither at baseline nor at 12 months follow up . Conclusions . Smoking cessation did not improve quality of life compared to sustained smoking after a coronary event in a 12 month follow up . Quality of life was not a significant predictor of smoking cessation Background Lifestyle measures of coronary heart disease ( CHD ) prevention have been overshadowed by the efficacy of drug treatments . This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering , anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials . Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects . Objectives The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years . In addition , an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study . Design A total of 197 patients with proven coronary heart disease were included and r and omised to a lifestyle intervention programme or to usual care . Follow-up was after a period of two years . Methods Intervention comprised a low fat diet , regular exercise , smoking cessation , psychosocial support and education , delivered by nurses on the rationale for pharmacological and lifestyle measures . Usual care comprised follow-up in the routine outpatient clinic . Both groups were given the same comprehensive medication according to recent guidelines . Results Patients in the lifestyle intervention group reduced the intake of saturated fat , sugar and cholesterol ( P<0.001 ) , increased their exercise level ( P<0.01 ) and stopped smoking ( P<0.05 ) when compared with the usual care group . A sub analysis of the influence of five-year CHD calculated risk in males result ed in a relative risk reduction of 22 % ( 95 % confidence intervals 9 - 35 ) . Although significant , this result must be interpreted with caution due to poor statistical power and reproducibility of the method . Conclusions In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet , exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males Background — Few prospect i ve studies have examined quantitative cigarette consumption and smoking cessation on sudden cardiac death ( SCD ) risk with long-term follow-up . Methods and Results — We prospect ively examined the association between cigarette smoking and smoking cessation on the risk of SCD among 101 018 women participating in the Nurses ’ Health Study without known coronary heart disease , stroke , and cancer at baseline 1980 . During 30 years of follow-up , we identified 351 SCD events . Compared with never smokers , current smokers had a 2.44-fold ( 95 % CI , 1.80–3.31 ) increased risk of SCD after controlling for coronary risk factors . In multivariable analyses , quantity of cigarettes smoked daily ( P value for trend , < 0.0001 ) and smoking duration ( P value for trend , < 0.0001 ) were linearly associated with SCD risk among current smokers . Small-to-moderate amounts of cigarette consumption ( 1–14 per day ) were associated with a significant 1.84-fold ( 95 % CI , 1.16–2.92 ) increase in SCD risk and every 5 years of continued smoking was associated with an 8 % increase in SCD risk ( hazard ratio , 1.08 ; 95 % CI , 1.05–1.12 ; P<0.0001 ) . The SCD risk linearly decreased over time after quitting and was equivalent to that of a never smoker after 20 years of cessation ( P value for trend , < 0.0001 ) . Conclusions — In this large prospect i ve cohort of women without coronary heart disease at baseline , a strong dose – response relationship between cigarette smoking and SCD risk was observed , and smoking cessation significantly reduced and eventually eliminated excess SCD risk . This suggests efforts to prevent SCD among women should include aggressive strategies for smoking cessation The relationship between selected baseline risk factors and subsequent coronary heart disease ( CHD ) death and total mortality among participants in the Multiple Risk Factor Intervention Trial ( MRFIT ) was studied in order to determine whether the three risk factors used to identify high-risk men for the trial were associated with CHD death ; whether other risk factors measured at baseline , especially lipoprotein cholesterol levels , were associated with CHD and total mortality ; and whether there were any differences between special intervention ( SI ) and usual care ( UC )  participants in the relationship of the specific levels of risk factors to CHD or total mortality . The three main risk factors ( blood cholesterol , cigarette smoking , and diastolic blood pressure ) and age were significantly associated with CHD mortality ; age , diastolic blood pressure , and cigarette smoking were associated with total mortality . The risk score based on the multiple logistic equation developed from the Framingham Study was also strongly associated with CHD mortality . When the joint associations of selected baseline risk factors with CHD and total mortality were considered , age , diastolic blood pressure , cigarette smoking , and low- and high-density lipoprotein cholesterol were significantly associated with CHD mortality ; age , cigarette smoking , and low-density lipoprotein cholesterol were positively associated with total mortality . Systolic blood pressure significantly improved the prediction of CHD mortality for SI and UC men when it was added to a regression model that included age , diastolic blood pressure , cigarettes smoked per day , body mass index , and lipoprotein levels , but improved the prediction of total mortality only for SI men . In similar analyses , serum thiocyanate improved the prediction of both CHD and total mortality for UC men . Among SI men the improved prediction gained by considering serum thiocyanate was less pronounced and not significant for CHD death . This latter finding may be due in part to the changes made in smoking behavior by SI participants during the course of the study . The estimated regression coefficients for CHD and total mortality endpoints were not significantly different between the SI and UC groups Smoking is the most important modifiable risk factor for coronary heart disease and its reduction is a target for primary health care.1 The participants in most studies of the smoking habits of patients with coronary heart disease are enrolled after acute cardiac events.2 There are few documented studies of the changes in the smoking habits of patients with angina . This study examined variations in self reported smoking habits over a five year period in a primary care cohort of patients diagnosed as having angina . Patients clinical ly diagnosed as having angina at least six months previously were identified from the disease registers of 18 general practice s in the Greater Belfast area . These general practice s were chosen to IMPORTANCE Lifestyle improvements after an acute coronary syndrome reduce cardiovascular risk but are difficult to achieve . OBJECTIVE To determine whether a nurse-led or dietician-led cardiovascular risk factor education program would improve risk factor reduction over the long term after an acute coronary syndrome . DESIGN , SETTING , AND PARTICIPANTS The Réseau Insuffisance Cardiaque ( RESICARD ) PREVENTION : study was a 2-arm , parallel-group , multicenter , r and omized clinical trial at 6 tertiary care hospitals in France . Patients hospitalized in a cardiac intensive care unit for an acute coronary syndrome with at least 1 lifestyle risk factor ( current smoking , sedentary lifestyle , or overweight or obesity ) were r and omized according to a computer-generated list with sequentially numbered , sealed envelopes . INTERVENTION Patients underwent an education program in a unique non-hospital setting ( a House of Education ) or were treated according to physicians ' usual st and ard of care . MAIN OUTCOMES AND MEASURES The primary outcome was a composite that included at least 1 of the following : smoking cessation , at least 3 hours per week of physical activity , at least 5 % reduction in weight , and at least 4 % reduction in waist circumference . Patients were followed up for 1 year . An intent-to-treat analysis was performed . RESULTS From June 21 , 2006 , to July 30 , 2008 , a total of 251 patients were r and omized to the House of Education and 251 to conventional care . The 2 groups did not differ significantly at 12 months in the primary composite outcome ( 51.8 % vs 49.8 % success rate ; adjusted relative risk [ aRR ] , 1.11 ; 95 % CI , 0.90 - 1.37 ) or with correction of all risk factors ( aRR , 1.22 ; 95 % CI , 0.89 - 1.66 ) . Similarly , the 2 groups did not differ by physical activity ( aRR , 1.05 ; 95 % CI , 0.92 - 1.21 ) , smoking cessation ( aRR , 0.99 ; 95 % CI , 0.87 - 1.13 ) , and weight or waist reduction ( aRR , 1.07 ; 95 % CI , 0.84 - 1.36 ) . CONCLUSIONS AND RELEVANCE Compared with conventional care , the House of Education did not result in superior improvement in lifestyle-related cardiovascular risk factors after an acute coronary syndrome . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00337480 Background : Little is known about the effects of changes in smoking habits on the subsequent risk of chronic obstructive pulmonary disease ( COPD ) . The aim of this study was to investigate the relationship between smoking cessation and reduction and admission to hospital for COPD in a general population sample . Methods : A total of 19 709 participants from three prospect i ve population studies in Copenhagen were followed with record linkage for date of first hospital admission for COPD until 1998 ( mean follow up 14 years ) . Heavy smokers ( ≥15 cigarettes/day ) who reduced their tobacco consumption by at least 50 % between the two initial examinations without quitting and smokers who stopped smoking during this time were compared with continuous heavy smokers using a Cox proportional hazards model . Results : During the follow up period 1260 subjects ( 741 men and 519 women ) were admitted to hospital for COPD . After multivariate adjustment , quitting smoking was associated with a significant reduction in the risk of hospital admission . The relative hazard ( HR ) was 0.57 ( 95 % confidence interval ( CI ) 0.33 to 0.99 ) . Those who reduced smoking did not show a significantly lower risk of hospitalisation than continuing heavy smokers ( HR 0.93 ( 95 % CI 0.73 to1.18 ) ) . Exclusion of events during the first 5 study years , detailed adjustment for lung function , or restriction of analyses to participants with impaired pulmonary function did not reverse the observed trend . Conclusions : Self-reported smoking cessation is associated with a reduction in the risk of COPD morbidity of approximately 40 % ; the benefit of smoking reduction is question able Background : Programs for smoking cessation for cardiac patients are underused in Canada . We examined the efficacy of an intervention for smoking cessation for patients admitted to hospital for coronary artery bypass graft ( CABG ) or because of acute myocardial infa rct ion ( MI ) . Methods : Nurses r and omly assigned 276 sequential patients admitted because of acute MI or for CABG who met the inclusion criteria . Participants received an intensive or minimal smoking-cessation intervention . The minimal intervention included advice from physicians and nurses and 2 pamphlets . The intensive intervention included the minimal intervention plus 60 minutes of bedside counselling , take-home material s and 7 nurse-initiated counselling calls for 2 months after discharge . The outcomes were point prevalence of abstinence at 3 , 6 and 12 months after discharge . Results : The 12-month self-reported rate of abstinence was 62 % among patients in the intensive group and 46 % among those in the minimal group ( odds ratio [ OR ] 2.0 , 95 % confidence interval [ CI ] 1.2–3.1 ) . Abstinence was confirmed for 54 % of patients in the intensive group and 35 % in the minimal group ( OR 2.0 , 95 % CI 1.3–3.6 ) . Abstinence was significantly lower among those who used pharmacotherapy than among those who did not ( p < 0.001 ) . Continuous 12-month abstinence was 57 % in the intensive group and 39 % in the minimal group ( p < 0.01 ) . It was significantly higher among patients admitted for CABG than among those admitted because of acute MI ( p < 0.05 ) . Interpretation : Providing intensive programs for smoking cessation for patients admitted for CABG or because of acute MI could have a major impact on health and health care costs Background Smoking cessation is probably the most important single action after a coronary event . In order to increase the effectiveness of smoking cessation programs , it is important to have knowledge of the predictors of smoking cessation . Further , it is unknown whether smoking cessation programs have impact on these predictors . Methods Data were obtained from a r and omized controlled trial of smoking cessation intervention in 240 smokers aged less than 76 years admitted for myocardial infa rct ion , unstable angina , or cardiac bypass surgery . Baseline characteristics were prospect ively recorded . Smoking cessation was determined by self report and biochemical verification at 12 months follow-up . Results In multivariate logistic regression analysis , a high level of nicotine addiction , low level of self-confidence in quitting and having previous coronary heart disease were significant negative predictors of smoking cessation at 12 months follow-up . Having previous coronary heart disease and a diagnosis other than acute myocardial infa rct ion as a reason for admission were important negative predictors of abstinence in the usual care group , in contrast to the intervention group , although this did not reach a level of significance in the subgroup interaction analyses . A high level of nicotine addiction was a strong negative predictor in both groups . Conclusion A high level of nicotine addiction is an important negative predictor of smoking cessation , even within an individualized smoking cessation program . Smoking cessation intervention seems to be especially effective in patients with previous coronary heart disease and in patients with unstable angina or coronary artery bypass surgery , compared to usual care Aims We assessed whether a novel programme to evaluate/communicate predicted coronary heart disease ( CHD ) risk could lower patients ' predicted Framingham CHD risk vs. usual care . Methods The Risk Evaluation and Communication Health Outcomes and Utilization Trial was a prospect i ve , controlled , cluster-r and omised trial in nine European countries , among patients at moderate cardiovascular risk . Following baseline assessment s , physicians in the intervention group calculated patients ' predicted CHD risk and were instructed to advise patients according to a risk evaluation/communication programme . Usual care physicians did not calculate patients ' risk and provided usual care only . The primary end-point was Framingham 10-year CHD risk at 6 months with intervention vs. usual care . Results Of 1103 patients across 100 sites , 524 patients receiving intervention , and 461 receiving usual care , were analysed for efficacy . After 6 months , mean predicted risks were 12.5 % with intervention , and 13.7 % with usual care [ odds ratio = 0.896 ; p = 0.001 , adjusted for risk at baseline ( 17.2 % intervention ; 16.9 % usual care ) and other covariates ] . The proportion of patients achieving both blood pressure and low-density lipoprotein cholesterol targets was significantly higher with intervention ( 25.4 % ) than usual care ( 14.1 % ; p < 0.001 ) , and 29.3 % of smokers in the intervention group quit smoking vs. 21.4 % of those receiving usual care ( p = 0.04 ) . Conclusions A physician-implemented CHD risk evaluation/communication programme improved patients ' modifiable risk factor profile , and lowered predicted CHD risk compared with usual care . By combining this strategy with more intensive treatment to reduce residual modifiable risk , we believe that substantial improvements in cardiovascular disease prevention could be achieved in clinical practice The purpose of the present study was to examine general practitioners ' abilities to make a correct estimation of the risk of coronary heart disease ( CHD ) .  A 10 % r and om sample of Norwegian primary care physicians ( n = 288 ) received a question naire that presented 10 case histories containing information about five CHD risk factors . The respondents ' risk estimation was compared with a composite score computed from epidemiologic data . The observed general tendency was towards underestimating the CHD risk . However , ' high-risk ' histories were recognized as CHD risk persons . Assessment of CHD risk due to multiple marginal abnormalities was only exceptionally correct . Hypercholesterolaemia and hypertension in men were acknowledged as contributing to clinical ly significant CHD risk only by a minority of GPs . Heavy smoking and a positive family history were associated with a more accurate estimation of CHD risk . Forty per cent of the physicians did not recognize the sex dependency of cholesterol as a CHD risk factor . None of the physician characteristics could predict variation in correct risk assessment
REVIEW ER 'S CONCLUSIONS Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD .
This 36 % risk reduction appears substantial compared with other secondary preventive therapies such as cholesterol lowering which have received greater attention in recent years .
The risk reduction associated with quitting smoking seems consistent regardless of differences between the studies in terms of index cardiac events , age , sex , country , and time period .
BACKGROUND Although the importance of smoking as a risk factor for coronary heart disease is beyond doubt , the speed and magnitude of risk reduction when a smoker with coronary heart disease quits are still subjects of debate .
OBJECTIVES To estimate the magnitude of risk reduction when a patient with CHD stops smoking .