title: Persistent smokers after myocardial infarction: a group that requires special attention.
abstract: BACKGROUND
  Despite the detrimental effects of smoking on the cardiovascular system, a significant number of patients with coronary heart disease continue to smoke. We aimed to record compliance to medication and attitude towards recommended lifestyle changes in patients who suffered from myocardial infarction (MI) and continued to smoke after the coronary event.
  
  
  METHODS
  A total of 1011 consecutive patients (<75 years) with a history of MI (>6 months) were recruited during the period 2000-2003 from the outpatient cardiology clinic of a district general hospital. All patients were interviewed and blood was taken for lipid measurements. Glycosylated haemoglobin (HbA(1 c)) was also measured in all diabetics.
  
  
  RESULTS
  Three hundred and twenty-nine (32.5%) patients reported smoking at interview, while 338 (33.5%) were ex-smokers of whom 278 (45.8% of all smokers) had quit smoking after MI and 344 (34%) had never smoked. Persistent smokers had significantly lower high-density lipoprotein cholesterol levels than nonsmokers (1.03+/-0.28 vs. 1.09+/-0.29 mmol/l, p=0.001). Persistent smokers with diabetes had poorer glycaemic control than nonsmoker diabetic patients as indicated by HbA(1c) levels (8+/-1.7% vs. 7.2+/-1.3%, p=0.001). Fewer persistent smokers were taking hypolipidaemic drugs than nonsmokers (31% vs. 40.3%, p=0.005). Finally, persistent smokers were less frequently performing regular exercise than nonsmokers (42% vs. 51%, p=0.008).
  
  
  CONCLUSIONS
  Patients who remain smokers after MI have a more negative attitude towards health aspects, are less compliant with their medications, and therefore constitute a high-risk subgroup, which requires special attention and should be professionally encouraged and supported to stop smoking.
authors.affiliation: Department of Cardiology, General Hospital of Nikea, Piraeus, Greece. rallidis@ath.forthnet.gr
authors.forename: Loukianos S
authors.initials: LS
authors.lastname: Rallidis
authors.forename: Eftichia S
authors.initials: ES
authors.lastname: Hamodraka
authors.forename: Valerios O
authors.initials: VO
authors.lastname: Foulidis
authors.forename: Georgios P
authors.initials: GP
authors.lastname: Pavlakis
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control / Q000534:rehabilitation*; D010349:Patient Compliance; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention