The study, which followed more than 1,500 heart attack survivors for 13 years, also found a survival advantage for smokers who did not quit but managed to cut down on cigarettes.

Israeli researchers found that compared with first-time heart attack sufferers who continued to smoke, those who quit were 37 percent less likely to die during the study period. That was close to the risk reduction seen among heart attack survivors who had never smoked -- who had a 43 percent lower risk of dying during the study than persistent smokers.

Meanwhile, patients who had quit smoking sometime before their heart attack were half as likely to die during the study period as smokers who kept up the habit.

The findings, reported in the Journal of the American College of Cardiology, bolster the case for routinely offering heart attack patients smoking-cessation counseling -- which other studies have suggested can lower the risk of further complications.

"Smokers who have had a heart attack should be provided with appropriate interventions to help them quit," write Dr. Yariv Gerber and colleagues from Tel Aviv University.

The study included 1,521 adults age 65 and older who were treated at one of eight Israeli hospitals for a first-time heart attack in 1992 or 1993. At the time, 27 percent had never smoked, 20 percent were former smokers, and more than half were current smokers. After hospital discharge, a majority of smokers tried to quit; 35 percent managed to remain continuously abstinent over the next 10 to 13 years.

A total of 427 patients died during the 13-year study period. The risk was greatest among those who had continued to smoke, even with factors like obesity, exercise habits, education and income, and overall health taken into account.

And while quitting altogether was best, smokers who cut back after their heart attack also improved their outlook, Gerber's team found.

Among the 381 patients who continued to smoke, the risk of dying during the study period declined by 11 percent for every five daily cigarettes they cut out.

The researchers point out that the quit rates in this study -- with more than one-third continuously abstinent for at least a decade -- were high as compared with the norm for smokers, but consistent with what's been seen for heart attack survivors.

They also note that the benefits of quitting, either before or after a heart attack, are at least as great as those of other common therapies to prevent further heart problems -- including cholesterol lowering, and use of aspirin and beta-blocker medications, which lower the risk of death by anywhere from 15 percent to 29 percent.

SOURCE: Journal of the American College of Cardiology, December 15/22, 2009.


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