Title: CHRONIC EXPOSURE TO SECOND HAND SMOKE AND 30DAY PROGNOSIS OF PATIENTS WITH ACUTE CORONARY SYNDROMES
1CHRONIC EXPOSURE TO SECOND HAND SMOKE AND 30-DAY
PROGNOSIS OF PATIENTS WITH ACUTE CORONARY
SYNDROMES
- Demosthenes B. Panagiotakos, DrMedSci, FESC, MACE
- Lecturer of Epidemiology
- Harokopio University, Athens, Greece
2Background
- Second hand smoke (SHS) has been investigated in
several studies before and it is now evident that
the risk of illness from SHS is - 2 to 10 that of the risk from active smoking.
3Aim of this work
- In the context of the GREECS study we tested
whether chronic exposure to SHS influences the
30-day prognosis of ACS patients.
4The GREECS Study
- The GREECS study is an observational study that
was designed to evaluate - clinical, lifestyle and behavioral factors
- associated with the severity and prognosis of
hospitalized patients with Acute Coronary
Syndromes (ACS). - Coordinating center First Cardiology Clinic,
School of Medicine, University of Athens, Greece
Pitsavos C, Panagiotakos DB, Antonoulas A, et
al., BMC Public Health 2005
5Sample of the Study
- Patients 2172 consecutive patients (1649 men,
65?13 years and 523 women, 72?11 years) with ACS
(MI or UA) that entered in the cardiology clinics
or the EU of 6 major hospitals, in Greece, were
enrolled in the study. - Enrolment period Between October, 2003 and
September, 2004
6Measurements
- Biochemical markers (CK-MB, Troponin I, etc)
- Clinical history
- Socio-demographic
- Psychological
- Behavioural
- Exposure to SHS was measured through a
questionnaire administrated during a specific
interview, after the second day of
hospitalisation. - SHSmokers were non- current smokers pts who were
exposed to environmental cigarette smoke (home or
workplace) for at least 30 min for gt5 days per
week.
7Design of the Study
Prognosis of ACS pts
Enrolment of ACS pts October 2003 to September
2004
- Assessment of baseline characteristics
- Socio-demographic
- Clinical
- Biological
- Lifestyle and behavioural
30-day
6-m
12-m
Death, or re-hospitalization due to CVD
8Background prognosis of MI pts
Risk of recurrent events
30-day
6-months
1-year
930-day Follow-up
- During the first 30-day following hospitalisation
information about vital status or
re-hospitalisation due to CVD retrieved from 1683
out of 2172 patients. - The event rate was
- 119 in males (9.2) and
- 38 in females (9.0),
- while 41 of them were fatal (25 in males, p for
gender differences 0.003).
10Characteristics of ACS pts according to 30-day
outcome
11SHS and ECG findings at presentation
- Mean duration of exposure to SHS was 29.6 ?16
years (median 30 years) - pts with ST-elevations reported longer exposure
to SHS compared to those who had
non-ST-elevations or other ECG abnormalities
(32?16 vs. 29?16 vs. 28?17 years, p0.009).
12SHS and indices of myocardial necrosis at
hospital admission
- A positive correlation was observed between years
of exposure to SHS and - Troponin I (r0.23, p0.001)
- CK-MB levels (r0.13, p0.001).
13Years of exposure to SHS and Troponin I (at entry)
Regression line is adjusted for age, sex,
physical activity status, presence of CVD risk
factors and smoking habits.
1430-day event rate (death or re-hospitalization)
and smoking habits of ACS pts
Plt0.001
Plt0.01
Plt0.1
156-month event rate (death or re-hospitalization)
and smoking habits of ACS pts
Plt0.009
Plt0.05
Plt0.07
16SHS and risk of 30-day re-current events
- ACS pts reporting exposure to SHS had
- 61 higher adjusted-risk of having a recurrent
CVD event during the first 30-day following
hospitalization as compared to pts who were not
exposed to SHS.
17Results from multiple logistic regression
analysis that evaluated the association of SHS
exposure on the 30-day prognosis of ACS patients.
18SHS and risk of 30-day re-current events
- A dose-response linear relationship was observed
between the risk of re-current events and the
years of exposure (rho0.17, plt0.001).
19(No Transcript)
20Limitations
- Self-reports of SHS exposure ? unable to evaluate
misreporting - Lack of biochemical evaluation of exposure ?
unable to evaluate misreporting - Information about continuing smoking or exposure
to SHS was retrieved after discharge ? bias due
to the CVD event
21Conclusion
- Although peoples right not to be exposed to SHS
at the workplace has become increasingly
recognised over the past years, it seems that in
Greece this right has been clearly infringed. - Since the late 1980s several Ministerial
Decisions (A2/1989, A2g/1980, 4508/ 1990 and
Y3/4322/1993) have prohibited smoking in
hospitals, private clinics, in places belonging
to State agencies, in private or public companies
and organisations, as well as during the flights
of all domestic airlines. - However, about 5 out of 10 pts reported exposure
to SHS!
22Conclusion
- SHS was associated with 61 higher odds of
recurrent events in pts who had had an ACS - 45 of the recurrent events in our sample were
attributable to the exposure to SHS. - The later may be due to the greater duration and
intention of exposure.
23What this work adds
- Our findings may clearly state a hypothesis for
the effect of exposure to SHS on a recurrent CVD
event among people with ACS.