Thursday, July 24, 2008

Smokers with coronary syndrome are younger, but don't have higher mortality rates
By Kelly Winget

In a new analysis of the SYNERGY trial database, researchers compared how well smokers, former smokers, and people who never smoked responded to two different types of anticoagulants to treat acute coronary syndrome. Researchers found that although current smokers required more angioplasty than the other patients, smokers had lower short-term mortality rates.

A number of DCRI researchers were involved in the study, and results were published in the July issue of the American Heart Journal.

Approximately 13 million Americans have coronary heart disease, and roughly 25 percent of patients who are admitted to hospitals for acute coronary syndrome (ACS) are smokers. ACS can include unstable angina or heart attacks.

For the study, researchers reviewed data on more than 9,900 patients with ACS, who self-reported their smoking status. Among the patients, 24 percent were current smokers, 35 percent were former smokers and 41 percent had never smoked. Studies have shown that smoking increases the risks of blood clots.

Patients were randomized to receive either heparin or enoxaparin – two heavily-studied anti-blood clot treatments. Although studies have indicated that both can lower risks of mortality or heart attacks, enoxaparin has a greater capability to block the formation of blood clots and researchers believed it could potentially be more beneficial to smokers as a result.

Researchers found that smokers were approximately 10 years younger than former smokers and patients who had never smoked. The smokers also had fewer coronary artery disease risks such as high blood pressure and diabetes.

The patients who were current smokers required more angioplasty procedures to widen arteries than former smokers and those who had never smoked. Despite this, former smokers had higher mortality rates by the 30-day follow-up point than current smokers. Smokers who received the enoxaparin treatment had lower mortality rates compared to both of the other patient groups.

Researchers also found that 62 percent of patients who were smokers at the time they were enrolled in the trial had quit by the 30-day follow up.

DCRI researchers involved with the study include Dianne Gallup, MS, Kenneth Mahaffey, MD, Robert Harrington, MD, and Robert Califf, MD, on behalf of the SYNERGY Trial Investigators.