CHRONIC EXPOSURE TO SECOND HAND SMOKE AND 30DAY PROGNOSIS OF PATIENTS WITH ACUTE CORONARY SYNDROMES

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CHRONIC 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

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Background

• 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.

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Aim 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.

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The 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
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Sample 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

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Measurements

• 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.

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Design 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
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Background prognosis of MI pts
Risk of recurrent events
30-day
6-months
1-year
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30-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).

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Characteristics of ACS pts according to 30-day
outcome
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SHS 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).

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SHS 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).

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Years 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.
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30-day event rate (death or re-hospitalization)
and smoking habits of ACS pts
Plt0.001
Plt0.01
Plt0.1
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6-month event rate (death or re-hospitalization)
and smoking habits of ACS pts
Plt0.009
Plt0.05
Plt0.07
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SHS 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.

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Results from multiple logistic regression
analysis that evaluated the association of SHS
exposure on the 30-day prognosis of ACS patients.
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SHS 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).

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Limitations

• 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

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Conclusion

• 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!

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Conclusion

• 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.

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What 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.