Stop Smoking, Prevent Sudden Death

It's no secret that smoking increases the risk of heart disease, but now a new study suggests that puffing on cigarettes also raises the risk of sudden cardiac death in people who already have heart disease.

But for people who are able to kick the habit, the increased risk of sudden death seems to disappear immediately, researchers report.

Sudden cardiac death occurs when a person's heart abruptly stops beating, and coronary artery disease - the clogging of arteries supplying the heart with blood - is the most common cause.

Smoking increases the risk of developing coronary artery disease, but it has been uncertain whether smoking increases the risk of sudden cardiac death in people who already have artery disease.

The current study, described in the journal Archives of Internal Medicine, included more than 3,000 people with coronary artery disease. Everyone in the study had either had a heart attack or had heart-related angina pain. Dr. Ilan Goldenberg of the Chaim Sheba Medical Center in Tel Hashomer, Israel, followed the participants for an average of about 8 years.

Current smokers were more than twice as likely to experience sudden cardiac death during the study than people who had never smoked, the researchers report.

In encouraging news for people who are able to quit smoking, however, the study found that former smokers had a similar risk of sudden cardiac death as people who had never smoked. No matter how long it had been since they quit, former smokers did not have an increased risk of sudden cardiac death.

"Our data indicate that continued cigarette smoking significantly elevates the risk of sudden cardiac death in patients with coronary artery disease," Goldenberg's team concludes.

The results underscore how important it is for people with heart disease to quit smoking, according to the researchers. They stress that "the decline in the risk of sudden cardiac death with smoking cessation is immediate."

According to the report, the fact that the increased risk of sudden cardiac death virtually disappears after a person stops smoking suggests that something in cigarette smoke has a direct toxic effect that increases the risk of sudden cardiac death. One possibility, the authors suggest, is that nicotine somehow triggers an irregular heart rhythm that can cause sudden cardiac death.

SOURCE: Archives of Internal Medicine, October 27, 2003.

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