Sex-specific predictive factors of smoking cessation in subjects at high cardiovascular risk - 01/08/24

Doi : 10.1016/j.acvd.2024.06.001

Ingrid Allagbé ^a,^b,^c,^⁎ , Marianne Zeller ^a,^c,^g, Daniel Thomas ^c,^d, Guillaume Airagnes ^b,^e, Frédéric Limosin ^e, Abdelali Boussadi ^f, Frédéric Chagué ^c,^g, Anne-Laurence Le Faou ^b,^c,^e,^h
^a Physiopathology and Epidemiology Cerebro-Cardiovascular, PEC2, EA 7460 UFR Health Sciences, University of Burgundy and Franche Comté, Dijon, France
^b University Paris Cité, AP–HP.Center, Outpatient Addictology Center, Paris, France
^c Groupement d’Intérêt Scientifique du Réseau Français d’Excellence de Recherche sur Tabac, nicotine et produit connexes (GIS REfer Tab), Paris, France
^d Université Paris-Sorbonne, AP–HP, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France
^e DMU Psychiatry and Addictology, AP–HP, Centre-University of Paris, Paris, France
^f Département de Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, AP–HP. Centre - Université de Paris, Paris, France
^g Cardiology Department, Dijon University Hospital, Dijon, France
^h Fédération Hospitalo-Universitaire Network of Research in Substance Use Disorder, Paris, France

^⁎Corresponding author. Team Physiology and Epidemiology Cerebro-Cardiovascular PEC2, EA 7460, University of Burgundy Franche-Comté, Dijon, France.Team Physiology and Epidemiology Cerebro-Cardiovascular PEC2, EA 7460, University of Burgundy Franche-ComtéDijonFrance

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Highlights

•	Smoking is a major risk factor for cardiovascular diseases.
•	Despite the benefits of smoking cessation (SC) the abstinence rate remains low.
•	Factors associated to success and failure of quit attempts differ according to sex.
•	Tailored SC interventions according to sex might help to improve smoking abstinence.
•	More intensive SC strategies in needed for smokers with diabetes, regardless of sex.

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Abstract

Smoking is a major risk factor for cardiovascular diseases (CVD), in particular in women, but smoking cessation (SC) reduces or even cancels the risk for both sexes. Using a nationwide SC services database, we aimed to determine the predictive factors of SC in men and women smokers with CV risk factors (CVRF) or CVD. A retrospective study from the French CDTnet database was conducted. Inclusion criteria were age ≥18years, and≥1 CVRF (Body Mass Index ≥25kg/m², hypertension, diabetes, hypercholesterolemia) or CVD (myocardial infarction (MI) or angina pectoris, stroke, peripheral arterial disease [PAD]). Self-reported smoking abstinence (≥28 consecutive days) was confirmed by exhaled carbon monoxide<10ppm. Logistic regression analysis assessed the association between SC and sociodemographic, medical characteristics, and smoking profile. Among the 36,864 smokers at high CV risk, abstinence rate was slightly lower in women than in men, (52.6% [n=8,102] vs 55.0% [n=11,848], P<0.001). For both sexes, factors associated with the lowest abstinence rates were diabetes, respiratory and psychiatric diseases, anxiolytic/antidepressant use, and cannabis consumption. In women, the factors associated with smoking abstinence were suffering from MI or angina and taking contraceptive pill and the factors associated with persistent smoking were alcohol disorder and high cigarette consumption. In men, there was a positive relationship between overweight and abstinence while being dual users of cigarettes and electronic cigarettes at first visit, having tobacco-related diseases (cancer and PAD) and taking opioid substitution treatment were associated with persistent smoking. Finally, in both sexes, the factors associated with abstinence were: age≥65years, having a diploma, being employed, self-referred or encouraged by entourage, ≥1 previous quit attempt, ≤20 cigarettes per day consumption, benefiting from SC medication prescription and ≥4 follow-up visits. In conclusion, our results suggest the relevance of SC intensive management in smokers at high CV risk, based on sociodemographic, medical, and smoking behaviour characteristics, as well as a gender-specific SC approach.