Influence of tobacco smoking on clinical efficacy of a 1-year rehabilitation programme for myocardial infarction patients of economically active age

Aim. Evaluation of the efficacy of 1-year exercise based program (EP) in coronary heart disease (CHD) patients of economically active age after acute myocardial infarction (MI), depending on smoking status.

Material and methods. To the study, males included (n=338) after MI (not later than 3 weeks from the event). Four groups shaped by randomization: EP patients smokers (group 1, n=84), EP non-smokers (group 2, n=85); no EP smokers (group 3, n=85) and no EP non-smokers (group 4, n=84). All patients received standard medication treatment. The EP were added, of moderate intensity (50-60% from the load in exercise test) 3 times a week during 1 year.

Results. After EP in smokers (n=41) and non-smokers (n=85) there was an increase of load duration by 30,3% (p<0,001) and by 28,4% (p<0,001), and its intensity by 31,2% (p<0,001) and 30,8% (p<0,001), with 3,8% (p<0,01) increase of economicity of physical work, but only in smokers. With no EP only in non-smokers there was slight increase of exercise duration by 10,1% (p<0,01) and its intensity by 11,1% (p<0,05), but milder, and in smokers, in contrary, the economicity parameter declined by 13,3% (p<0,05). This was linked with the heart size enlargement and the left ventricle ejection fraction increase in smokers and non-smokers; in the absence of EP there were no changes, just slight (by 1,9%) (p<0,05) increase of the left ventricle ejection fraction in non-smokers. Only at EP, with similar grade in smokers and non-smokers there was decrease of atherogenic lipids levels and high density cholesterol increase. In 1 year of EP, all cases of cardiovascular adverse events significantly decreased in smokers by 44,8% (р<0,05) and in nonsmokers by 50,9% (р<0,05).

Conclusion. Long term (1 year) EP of moderate intensity, in both smokers and non-smokers MI patients lead to stable disease course, decrease the rate of cardiovascuar complications and improve patients life quality. However the “smoking factor” decreases rehabilitational potentional of patient and interferes with better results achievement in cardiorehabilitation.

1. Timmis A, Townsend N, Gale C, et al. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018;39:508-77. doi:10.1093/eurheartj/ehx628.

2. Jernberg T, Hasvold P, Henriksson M, et al. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36:1163-70. doi:10.1093/eurheartj/ehu505.

3. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290(7):898-904. doi: 10.1001/jama.290.7.898.

4. Weintraub WS, Klein LW, Seelaus PA, et al. Importance of total life consumption of cigarettes as a risk factor for coronary artery disease. Am J Cardiol. 1985;55:669-72.

5. Gambardella J, Sardu C, Sacra C, Santulli G. Quit smoking to outsmart atherogenesis: Molecular mechanisms underlying clinical evidence. Atherosclerosis. 2017;257:2425. doi:10.1016/j.atherosclerosis.2016.11.016.

6. Hasdai D, Garratt KN, Grill DE, et al. Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. N Engl J Med. 1997;336:755-61. doi:10.1056/NEJM199703133361103.

7. Krasnitskyi VB, Aronov DM, Dzhankhotov SO. Study of physical activity in the patients with ischemic heart disease by special questionnaire “QPHA-23+”. Cardiovascular Therapy and Prevention. 2011;8:90-7. (In Russ.)

8. Zieske AW, Takei H, Fallon KB, Strong JP. Smoking and atherosclerosis in youth. Atherosclerosis. 1999;144:403-8. PII: S0021-9150(98)00326-8.

9. Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. JACC. 2004;43:1731-7. doi:10.1016/j.jacc.2003.12.047.

10. Barreiro E, Puerto-Nevado L, Puig-Vilanova E, et al. Cigarette smoke-induced oxidative stress in skeletal muscles of mice. Respir Physiol Neurobiol. 2012;182(1):917. doi:10.1016/j.resp.2012.02.001.

11. Rinaldi M, Maes K, De Vleeschauwer S, et al. Long-term nose-only cigarette smoke exposure induces emphysema and mild skeletal muscle dysfunction in mice. Dis Model Mech 2012;5(3):333-41. doi:10.1242/dmm.008508.

12. Aronov DM, Bubnova MG, Barbarash OL, et al. Russian clinical guidelines “Acute ST-segment elevation myocardial infarction: rehabilitation and secondary prevention. Russian Journal of Cardiology. 2014;1(117):1-52. (In Russ.) doi:10.15829/1560-4071-2015-01-6-52.

13. Bustamante MJ, Valentino G, Krämer V, et al. Patient Adherence to a Cardiovascular rehabilitation program: what factors are involved? intern j clin med. 2015;6:605-14. doi:10.4236/ijcm.2015.69081.

14. Bubnova MG, Aronov DM, Oganov RG, et al. (on behalf of the study investigators). Clinical characteristics of stable angina patients and their treatment strategies in real-world clinical practice. A Russian PERSPECTIVE Study (Part I). Cardiovascular Therapy and Prevention. 2010;6:47-56. (In Russ.)

15. Prugger Ch, Wellmann J, Heidrich J, et al. on behalf of the EUROASPIRE Study Group. Passive smoking and smoking cessation among Patients with coronary heart disease across Europe: results from the EUROASPIRE III survey. Eur Heart J. 2014;35:590-8. doi:10.1093/eurheartj/eht538.