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Cited by 26Lipoproteins and Cardiovascular HealthSmoking Behavior and CessationAcute Myocardial Infarction Research

The Impact of Smoking on Cardiovascular Outcomes and Comorbidities in Statin-treated Patients with Coronary Artery Disease: A Post hoc Analysis of the GREACE Study

Athyros, Vasilios G., Tziomalos, Konstantinos, Katsiki, Niki, Gossios, Thomas D., Giouleme, Olga, Anagnostis, Panagiotis, Pagourelias, Efstathios D., Theocharidou, Eleni +3 more·2013·Current Vascular Pharmacology
DOI 10.2174/1570161111311050016
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Abstract

BACKGROUND: Smoking adversely affects cardiovascular disease (CVD) morbidity and mortality; however the effect of long-term statin treatment in high risk smokers is not entirely clear. The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study (n=1,600 patients with established coronary heart disease, mean follow-up 3-years) was the incidence of major CVD events, a composite of death, myocardial infarction, revascularization, unstable angina, heart failure, and stroke in statin-treated patients (n=880) who continued to smoke (n=129) compared with ex-smokers (n=309) and never smokers (n=442) as well as on patients not treated with a statin (n=720) of all smoking categories. Secondary endpoints were the effect of smoking on chronic kidney disease (CKD) and on non-alcoholic fatty liver disease (NAFLD), two major and common independent CVD risk factors. RESULTS: Among statin treated patients the hazard ratio (HR) for current smokers compared with never smokers was 1.86 [95% confidence interval-(CI) 1.19-2.10); similar was the HR for current smokers compared with ex-smokers. Absolute (16.3%) and relative (45.6%) CVD risk reduction was great in current smokers on statins compared with those not on a statin; however they still had the highest absolute CVD event incidence (19.4%). Low high density lipoprotein cholesterol and higher triglycerides may account, at least in part, for this. The highest risk of CVD events in any of the 6 groups was in the smokers not on a statin (35.7%). CKD and NAFLD were not negatively affected by smoking and they do not appear to be implicated in the adverse effect of smoking on CVD event rate in patients on a statin. CONCLUSIONS: Statins reduce CVD morbidity and mortality in current smokers with CVD, but these remain high in terms of absolute incidence compared with ex- and never smokers. CKD and NAFLD are not affected by smoking and do not seem to contribute to this high CVD event incidence. These make smoking cessation imperative in high risk patients even if they are on statins.

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  • Many epidemiological studies have reported that regardless of age and gender, the risk of recurrence of cardiovascular events decreases by approximately half after the first year of smoking cessation and continues to decrease thereafter.

    “Many epidemiological studies have reported that regardless of age and gender, the risk of recurrence of cardiovascular events decreases by approximately half after the first year of smoking cessation and continue to decrease thereafter.”

    From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [786]

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Authors
Athyros, V. G., Tziomalos, K., Katsiki, N., Gossios, T. D., Giouleme, O., Anagnostis, P., Pagourelias, E. D., Theocharidou, E., Karagiannis, A., Mikhailidis, D. P., & for the GREACE Study Collaborative Group
Affiliations
The Royal Free Hospital (GB)
ORCID
Venue
Current Vascular Pharmacology
Publisher
Bentham Science Publishers Ltd.
Published
2013-08-31
Volume
11
Issue
5
Pages
779-784
ISSN
1570-1611 (ISSN-L)
DOI
10.2174/1570161111311050016
OpenAlex
W2150968279
Cited by
26
References
0
Citations by year
2026: 1 · 2025: 1 · 2022: 2 · 2021: 1 · 2019: 6 · 2018: 1 · 2017: 1 · 2015: 3 · 2014: 5 · 2013: 5
FWCI
4.26
Type
journal article
Language
en
Open access
closed
Locations
  • Current Vascular Pharmacology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
smoking, statins, coronary artery disease, cardiovascular events, atorvastatin, chronic kidney disease, non-alcoholic fatty liver disease, smoking cessation, HDL cholesterol, triglycerides, cardiovascular risk reduction
MeSH terms
Cardiovascular Diseases, Coronary Artery Disease, Fatty Liver, Female, Humans, Male, Middle Aged, Prospective Studies, Smoking, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Renal Insufficiency, Chronic, Non-alcoholic Fatty Liver Disease

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