Smokers and Postcessation Weight Gain After Acute Coronary Syndrome

Payam Dehghani, Bettina Habib, Sarah B Windle, Nathalie Roy, Wayne Old, François R Grondin, Iqbal Bata, Ayman Iskander, Claude Lauzon, Nalin Srivastava, Adam Clarke, Daniel Cassavar, Danielle Dion, Herbert Haught, Shamir R Mehta, Jean-François Baril, Charles Lambert, Mina Madan, Beth L Abramson, Mark J Eisenberg, Payam Dehghani, Bettina Habib, Sarah B Windle, Nathalie Roy, Wayne Old, François R Grondin, Iqbal Bata, Ayman Iskander, Claude Lauzon, Nalin Srivastava, Adam Clarke, Daniel Cassavar, Danielle Dion, Herbert Haught, Shamir R Mehta, Jean-François Baril, Charles Lambert, Mina Madan, Beth L Abramson, Mark J Eisenberg

Abstract

Background: Smoking cessation and weight management are recommended after acute coronary syndrome (ACS); however, little is known about the effects of smoking cessation on weight change after ACS. We aimed to assess the effect of smoking cessation after ACS on weight over a 12-month follow-up period.

Methods and results: Data were prospectively collected from the EVITA (Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome) trial. Weight change was compared among 3 groups of patients: those who were completely abstinent (n=70), those who smoked intermittently (n=68), and those who smoked persistently (n=34). Patients' mean baseline weight was 83.9 kg (SD 17.7) with a mean body mass index of 28.5 (SD 5.4). Patients smoked a mean of 37.7 years (SD 17.7) and a mean of 21.0 cigarettes (SD 9.0) per day prior to their ACS. Weight change varied across groups, with abstainers gaining a mean of 4.8 kg (SD 8.6), intermittent smokers gaining a mean of 2.0 kg (SD 8.9) and persistent smokers losing a mean of 0.7 kg (SD 7.4). At 52 weeks, abstainers were more likely to gain weight than persistent smokers (difference in means 5.5 kg; 95% CI 2.3-8.8). This weight gain was not associated with an increase in the use of antihypertensive or antidiabetic medications.

Conclusions: Following an ACS, significant weight is gained by patients who quit smoking. Weight-management interventions among smokers who quit after ACS should be a focus of investigation in future research so that the cardiovascular benefits achieved by smoking cessation are not offset by weight gain in this high-risk population.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794573.

Keywords: acute coronary syndrome; secondary prevention; smoking; weight gain.

© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Proportion of patients with >5% body weight gain or loss according to pattern of smoking at 52 weeks. Compared with persistent smokers, many more abstainers gained >5% of their body weight over 12 months of follow‐up.
Figure 2
Figure 2
Weight changes within and between different categories of smokers. A significant difference in change of weight from baseline to 52 weeks was observed between smokers who became abstainers and smokers who continued to smoke persistently.
Figure 3
Figure 3
Changes in BMI according to pattern of smoking at week 52. The most notable change in BMI over the course of follow‐up was observed in the abstainers. The patients classified as obese (BMI ≥30.0) changed from 33% to 51%. BMI indicates body mass index.
Figure 4
Figure 4
Changes in blood pressure according to percentage body weight gain. The entire cohort's blood pressure increased over the course of follow‐up with a numerically higher increase in systolic blood pressure in patients who gained >5%.

References

    1. Rea TD, Heckbert SR, Kaplan RC, Psaty BM, Smith NL, Lemaitre RN, Lin D. Body mass index and the risk of recurrent coronary events following acute myocardial infarction. Am J Cardiol. 2001;88:467–472.
    1. Critchley J, Capewell S. Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev. 2004;1:CD003041.
    1. Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, Gibbons RJ, Grundy SM, Hiratzka LF, Jones DW, Lloyd‐Jones DM, Minissian M, Mosca L, Peterson ED, Sacco RL, Spertus J, Stein JH, Taubert KA; World Heart F, the Preventive Cardiovascular Nurses A . AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458–2473.
    1. Zhang YJ, Iqbal J, van Klaveren D, Campos CM, Holmes DR, Kappetein AP, Morice MC, Banning AP, Grech ED, Bourantas CV, Onuma Y, Garcia‐Garcia HM, Mack MJ, Colombo A, Mohr FW, Steyerberg EW, Serruys PW. Smoking is associated with adverse clinical outcomes in patients undergoing revascularization with PCI or CABG: the SYNTAX trial at 5‐year follow‐up. J Am Coll Cardiol. 2015;65:1107–1115.
    1. Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta‐analysis of cohort studies. Arch Intern Med. 2000;160:939–944.
    1. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290:86–97.
    1. Gerber Y, Rosen LJ, Goldbourt U, Benyamini Y, Drory Y; Israel Study Group on First Acute Myocardial I . Smoking status and long‐term survival after first acute myocardial infarction a population‐based cohort study. J Am Coll Cardiol. 2009;54:2382–2387.
    1. Janzon E, Hedblad B, Berglund G, Engstrom G. Changes in blood pressure and body weight following smoking cessation in women. J Intern Med. 2004;255:266–272.
    1. Nilsson P, Lundgren H, Soderstrom M, Fagerstrom KO, Nilsson‐Ehle P. Effects of smoking cessation on insulin and cardiovascular risk factors—a controlled study of 4 months' duration. J Intern Med. 1996;240:189–194.
    1. Grandi SM, Filion KB, Gervais A, Joseph L, O'Loughlin J, Paradis G, Rinfret S, Pilote L, Grondin FR, Lutchmedial S, Eisenberg MJ. Weight change in patients attempting to quit smoking post‐myocardial infarction. Am J Med. 2014;127:641–649.e641.
    1. Eisenberg MJ, Windle SB, Roy N, Old W, Grondin FR, Bata I, Iskander A, Lauzon C, Srivastava N, Clarke A, Cassavar D, Dion D, Haught H, Mehta SR, Baril JF, Lambert C, Madan M, Abramson BL, Dehghani P; Investigators E . Varenicline for smoking cessation in hospitalized patients with acute coronary syndrome. Circulation. 2016;133:21–30.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict. 1991;86:1119–1127.
    1. Beck AT, Steer RA, Ball R, Ciervo CA, Kabat M. Use of the Beck Anxiety and Depression Inventories for primary care with medical outpatients. Assessment. 1997;4:211–219.
    1. Stevens J, Truesdale KP, McClain JE, Cai J. The definition of weight maintenance. Int J Obes. 2005;30:391–399.
    1. Eisenberg MJ, Grandi SM, Gervais A, O'Loughlin J, Paradis G, Rinfret S, Sarrafzadegan N, Sharma S, Lauzon C, Yadav R, Pilote L; Investigators Z . Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction: a randomized, placebo‐controlled trial. J Am Coll Cardiol. 2013;61:524–532.
    1. Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, Diaz R, Rashed W, Freeman R, Jiang L, Zhang X, Yusuf S; Investigators IS . Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case‐control study. Lancet. 2006;368:647–658.
    1. Fadl YY, Krumholz HM, Kosiborod M, Masoudi FA, Peterson PN, Reid KJ, Weintraub WS, Buchanan DM, Spertus JA. Predictors of weight change in overweight patients with myocardial infarction. Am Heart J. 2007;154:711–717.
    1. Lopez‐Jimenez F, Wu CO, Tian X, O'Connor C, Rich MW, Burg MM, Sheps D, Raczynski J, Somers VK, Jaffe AS. Weight change after myocardial infarction—the Enhancing Recovery in Coronary Heart Disease patients (ENRICHD) experience. Am Heart J. 2008;155:478–484.
    1. Shore S, Jones PG, Maddox TM, Bradley SM, Stolker JM, Arnold SV, Parashar S, Peterson P, Bhatt DL, Spertus J, Ho PM. Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction. Heart. 2015;101:800–807.
    1. Filozof C, Fernandez Pinilla MC, Fernandez‐Cruz A. Smoking cessation and weight gain. Obes Rev. 2004;5:95–103.
    1. Koopmann A, Dinter C, Grosshans M, von der Goltz C, Hentschel R, Dahmen N, Gallinat J, Wagner M, Grunder G, Thurauf N, Wienker T, Brinkmeyer J, Mobascher A, Spreckelmeyer KN, Clepce M, de Millas W, Wiedemann K, Winterer G, Kiefer F. Psychological and hormonal features of smokers at risk to gain weight after smoking cessation—results of a multicenter study. Horm Behav. 2011;60:58–64.
    1. Clair C, Rigotti NA, Porneala B, Fox CS, D'Agostino RB, Pencina MJ, Meigs JB. Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes. JAMA. 2013;309:1014–1021.
    1. Facchini FS, Hollenbeck CB, Jeppesen J, Chen YD, Reaven GM. Insulin resistance and cigarette smoking. Lancet. 1992;339:1128–1130.
    1. Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J. 2011;161:145–151.
    1. Eliasson B, Attvall S, Taskinen MR, Smith U. Smoking cessation improves insulin sensitivity in healthy middle‐aged men. Eur J Clin Invest. 1997;27:450–456.
    1. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53:1925–1932.
    1. Lavie CJ, De Schutter A, Patel D, Artham SM, Milani RV. Body composition and coronary heart disease mortality—an obesity or a lean paradox? Mayo Clin Proc. 2011;86:857–864.
    1. Lavie CJ, De Schutter A, Patel DA, Milani RV. Body composition and fitness in the obesity paradox—body mass index alone does not tell the whole story. Prev Med. 2013;57:1–2.
    1. Senechal M, Swift DL, Johannsen NM, Blair SN, Earnest CP, Lavie CJ, Church TS. Changes in body fat distribution and fitness are associated with changes in hemoglobin A1c after 9 months of exercise training: results from the HART‐D study. Diabetes Care. 2013;36:2843–2849.

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