title: Passive tobacco exposure may impair symptomatic improvement in patients with chronic angina undergoing enhanced external counterpulsation.
abstract: BACKGROUND
  The adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP).
  
  
  METHODS
  This observational study included 1,026 non-smokers (108 exposed and 918 not-exposed to SHS) from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment.
  
  
  RESULTS
  Non-smoking SHS subjects had a lower prevalence of prior revascularization (85% vs 90%), and had an increased prevalence of stroke (13% vs 7%) and prior smoking (72% vs 61%; all p < 0.05) compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course (77% vs 85%, p = 0.020) compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP (angina class decreased > or = 1 class: 68% vs 79%; p = 0.0082), both higher than that achieved in current smokers (66%). By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers (OR 1.81, 95% confidence intervals 1.16-2.83).
  
  
  CONCLUSIONS
  Non-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Utah, Salt Lake City, Utah, USA. stilianos.efstratiadis@hsc.utah.edu
authors.forename: Stilianos
authors.initials: S
authors.lastname: Efstratiadis
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Kennard
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy*; D002908:Chronic Disease; D015908:Counterpulsation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D017211:Treatment Failure; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution
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