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HEART Insight:
doi: 10.1097/01.HEARTI.0000300683.11514.6f
Features: Medicine Chest/Quitters Always Win

Ready To Kick That Smelly Smoking Habit? What You Need To Know To Succeed

Lippert, Joan

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For 32 years, cartoonist Frank Cummings smoked one to two packs of cigarettes a day. “I tried to quit a dozen times,” says Frank, 48. “The longest I lasted was six months. Then there would be some kind of stress, and I'd go right back.”

Figure. FRANK CUMMIN...
Figure. FRANK CUMMIN...
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In time, Frank found that doing the most routine things tired him out. He began to have trouble breathing. He also noticed heaviness in his legs; sometimes his hands and feet felt tingly and cold (not something he could chalk up to chilly weather — he lives in Birmingham, AL). “It scared me,” he says. “I felt like I was on the threshold of something big.”

Maybe you're a smoker with similar symptoms. Maybe you've had a heart attack, stroke or smoking-related medical problem. But even if you have no symptoms now, you can help stave off future medical problems and gain a few extra years of life if you quit.

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WHY QUIT — TODAY?

On average, nonsmokers live several years longer than smokers, and not just because their lungs are healthier. “I tell my patients that even after a heart attack, quitting smoking is equivalent to lowering your cholesterol by 100 points,” says Ira S. Ockene, M.D., Director of the Preventive Cardiology Program at the University of Massachusetts Memorial Medical Center in Worcester. (Ockene testified as an expert witness for the federal government in its case against tobacco company Philip Morris in 2005.)

On the first day you quit, your circulation, blood pressure and heart rate should improve; 15 years after you quit, your heart disease risk will be the same as someone who has never smoked.

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WHAT'S GOING ON IN THERE?

Smoking's effects inside your body aren't pretty. Smoking increases your risk of heart attack and stroke by making your blood “stickier” and more likely to clot; cutting your high-density lipoprotein (HDL) cholesterol (the “good” cholesterol); and increasing carbon monoxide (yes, the same gas that comes out of your car's tailpipe!) in your blood, robbing your body of vital oxygen. In addition, the nicotine in cigarettes raises your blood pressure while it's in your system.

Smoking also damages the insides of your arteries and blood vessels, which stiffens them over the years and makes fatty buildup more likely. This damage not only increases heart attack and stroke risk but may cause pain, cramping or aching in your legs when you walk (peripheral artery disease).

People who have diabetes are in even greater danger of adverse cardiovascular effects. “As a cardiologist, I constantly see the ravages of cigarette smoking — not only shortness of breath or damaged coronary arteries but also gangrene and poor blood circulation in my patients with diabetes,” says Ockene. Smoking can make the blood vessel damage of diabetes worse, leading to leg and foot infections, even disability. According to recent research, smoking also makes controlling blood sugar more difficult, as well as blunting the benefits of inhaled insulin. Diabetics die of heart disease more than any other cause.

Table. THE BENEFITS ...
Table. THE BENEFITS ...
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OPTIONS APLENTY

Stopping smoking abruptly with no outside help — cold turkey — is cheap, and you can do it at home. This method is popular among teens and others who are not aware of the variety of available treatment options. But does it work? Researchers report only about a five percent success rate. “It's a remarkably unsuccessful way to quit,” says Douglas E. Jorenby, Ph.D., Director of Clinical Services at the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health in Madison.

Fortunately, more quit-smoking help is available to America's 46 million smokers than ever before; experts advise that you can even combine some options for the best chance of success:

COUNSELING. Support groups can be great motivators. “I've heard people say, ‘I would have smoked, but didn't want to have to tell the group I slipped,’” says Jorenby. Groups are also pools of advice: “I got through that ... I called my best friend.” Alternatively, one-on-one counseling can be tailored to your needs — you don't have to listen to someone talk about something that doesn't apply to you, notes Jorenby. If you'd rather not go to meetings or sessions, telephone quit lines may help. Counseling increases your chances of quitting from 20 percent (telephone) to 30 percent (group) to 70 percent (face-to-face).

NICOTINE REPLACEMENT. Nicotine is the addictive substance in cigarettes. Nicotine replacement products minimize withdrawal symptoms (among them, depressed mood, disrupted sleep, irritability, frustration and anger) while sparing you many other harmful substances in smoke as you taper the dose and break the habit. Nicotine replacement increases your chances of quitting by 50 percent (gum) to 180 percent (inhaler).

* Nicotine gum and lozenges. Over-the-counter (OTC) nicotine gum and lozenges release nicotine into your bloodstream through the lining of your mouth. They work better when you don't drink coffee, juice or other acidic beverages. The gum isn't the best choice for people with temporomandibular joint (TMJ) syndrome, dentures, braces or bridges, because frequent chewing and the gum's stickiness can make TMJ worse, and the gum is likely to stick to dental work.

* The nicotine patch. Available OTC, the patch provides a steady supply of nicotine to your body. Anyone who has skin problems or adhesive allergies shouldn't use the patch. Also, some people can experience vivid or frightening dreams if they wear the patch at night.

* Nicotine nasal spray. Available by prescription, this is the fastest delivery system. Not recommended for people with nasal or sinus conditions, allergies or asthma, it may cause sneezing, coughing and watery eyes.

* Nicotine inhaler. This prescription method delivers a nicotine mist absorbed through the mouth and throat. Side effects include mouth and throat irritation and coughing; people who have asthma or other lung conditions should use with caution.

A nicotine vaccine is in development, as is a nicotine oral solution that can taste good when added to a drink, says researcher Eric C. Westman, Medical Director of the Duke Center for Nicotine and Smoking Cessation Research in Durham, NC.

Though safer than smoking, nicotine replacement therapy may not be for you — especially if you've had a heart attack, irregular or rapid heartbeat, or chest pain — so get your doctor's OK first. And though nicotine replacement therapy products are considered safe for adolescents, no studies on the long-term safety in this age group have been published. One more thing to consider: there is potential for abuse of nicotine replacement products.

Stronger medicines. For hard cases, the doctor can prescribe the antidepressant bupropion or varenicline, which blocks nicotine's effects in the brain. Either drug can double your chances of success.

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WHEN ALL ELSE FAILS

If you've tried to quit smoking and relapsed several times, or have a pressing need to quit — “for example, if you're a candidate for a heart transplant,” says Treatment Program Coordinator Michael Burke, Ed.D. — the Mayo Clinic's Nicotine Dependence Center in Rochester, MN, offers an intensive live-in program. The eight-day program costs $5,000, part or all of which is covered by most health insurance plans.

James McCarthy, 53, of Rock Island, IL, is a successful graduate. A smoker since age 15, he had a massive heart attack in 2004, followed by heart failure, and was lucky enough to get on the Mayo Clinic heart transplant list. He was required to complete the quit-smoking program before surgery.

“What affected me the most was the educational aspect,” he says. “They explain all the different ingredients in tobacco and show pictures of what smoking does to your body — it's bad!” James also used a nicotine patch. He received his new heart in August 2006, and is doing well today.

Figure. James McCart...
Figure. James McCart...
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A desperate desire to stop smoking also goes a long way toward making a quit attempt stick. Social isolation and marriage to a nonsmoker did it for heavy smoker Gail Adams, 56, of Hartford, CT. She quit with counseling alone 25 years ago, and has never looked back. “Everybody in my family smoked,” she says. Her mother, father and brother remained lifelong smokers — and have all since passed away from cancer, heart disease or lung disease.

And Frank the cartoonist? He used a nicotine patch for a few weeks to minimize the most intense withdrawal symptoms, but “it still came down to determination and willpower,” he says. “This past October was two years since I quit — the longest two years of my life.” All of his symptoms are fading or gone. He walks two miles a day — originally a way to dispel the urge to smoke, but now a good habit he's hung on to.

“I feel like I did when I was 20 and look 100 times better than I did when I was smoking,” says Frank. “The most amazing things happen when you quit poisoning yourself.”

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Resources for Quitters

Each year, 1.3 million smokers quit. Ready to join them? Success is at your fingertips, with these helpful Web sites: American Heart Association www.americanheart.org/quitsmoking

Freedom From Smoking®, an online smoking cessation program by the American Lung Association www.ffsonline.org/

American Cancer Society www.cancer.org 800-ACS-2345

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American Diabetes Association www.diabetes.org/type-1-diabetes/smoking.jsp

National Cancer Institute www.smokefree.gov 800-QUITNOW

© 2007 American Heart Association, Inc.

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