Society position statementSmoking Cessation and the Cardiovascular Specialist: Canadian Cardiovascular Society Position Paper
Section snippets
Smoking and the Cardiovascular Patient
In Canada there have been distinct changes in societal attitudes toward smoking, with a dramatic decrease in the tolerance of smoking in public spaces and indoor environments. Clinical approaches to the treatment of nicotine addiction have often reflected a serendipitous delivery of educational and exhortational messages. It has been noted, sadly, that tobacco addiction represents “a unique combination of prevalence, lethality, and … neglect.”18 Evidence continues to accumulate, however,
Nicotine Addiction in the Cardiovascular Setting
Smokers frequently experience a range of unpleasant moods and physical symptoms (eg, irritability, nervousness, increased appetite, depression, difficulty concentrating), referred to as “tobacco withdrawal syndrome,” when they cannot smoke.4, 36, 37 The development of nicotine withdrawal following hospitalization is more common than realized and contributes to patient discomfort, behavioural “challenges,” and lack of compliance with treatment. The prevention and treatment of withdrawal in the
Smoking Cessation Pharmacotherapy
There are currently 3 classes of pharmacotherapy for smoking cessation: nicotine-replacement therapy (NRT); bupropion; and varenicline. Cardiovascular specialists should be familiar with the benefits, limitations, use, and prescription of smoking cessation therapies when and where appropriate. These treatments, like many cardiovascular disease therapies, can subsequently be supervised by a primary care physician and/or other allied health professional. All pharmacotherapies are intended to
Acupuncture, Hypnotherapy, and Related Treatments
The popularity and often aggressive advertising that surround these interventions notwithstanding, there is little evidence to support their use as effective, fundamental approaches to cessation.51, 52, 53
Other Elements of Cessation Treatment
Innovative approaches for the ongoing follow-up and management of those engaged in smoking-cessation attempts are now available in many forms and in many community settings. They include primary care programs, community cessation resources (eg, Quitlines), and ongoing follow-up that makes use of sophisticated telephone techniques. Smoking cessation is an integral component of any multifactorial cardiac rehabilitation program, and participation in such programs has been associated with important
Summary
The management of tobacco addiction and smoking cessation are of critical clinical importance to all cardiovascular specialists. It is important that they take the following steps (see Table 1 also):
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Introduce a systematic approach to the delivery of smoking cessation interventions in all of their professional settings. Clinical practice guidelines have stressed the importance of system changes to embed treatment for nicotine dependence in institutional policies and practice.26, 59, 60 Examples
Acknowledgements
This position statement was presented at the Annual Conference of the Canadian Cardiovascular Society in Montreal in October 2010. The authors (the “Primary Panel”) gratefully acknowledge the contributions provided by members of the “Secondary Panel” who carefully reviewed the position statement prior to its presentation to the Canadian Cardiovascular Society: Sandeep Aggarwal, MD; Michael Baird, MD; Jeffrey Burton, MD; Gilles Dagenais, MD; Anthony Graham, MD; Paul Hendry, MD; Lyall Higginson,
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National Trends of Gender Disparity in Canadian Cardiovascular Society Guideline Authors, 2001-2020
2021, CJC OpenCitation Excerpt :There were 9 CCS guidelines for which women represented 50% or more of the authors (6 from heart failure, 2 from pediatric cardiology, and 1 from general cardiology).12-20 Remarkably, there were 7 guidelines for which no women were included as authors on the committees (Supplemental Table S2).21-27 We extracted 609 (25.6% women, 74.4% men, P < 0.0001) unique authors after accounting for repeat authorship, including both MD and non-MD authors (Supplemental Table S3).
Vaping, Smoking Cessation, and Harm Reduction? Look Before You Leap
2021, Canadian Journal of CardiologySmoking Cessation and Cardiac Rehabilitation: A Priority!
2018, Canadian Journal of CardiologyCardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management
2018, Canadian Journal of CardiologyInfluence of Exposure to Bisphenols on Cardiac Structure/Function
2018, Comprehensive Toxicology: Third EditionEffects of varenicline and nicotine replacement therapy on arterial elasticity, endothelial glycocalyx and oxidative stress during a 3-month smoking cessation program
2017, AtherosclerosisCitation Excerpt :Furthermore, malondialdehyde (MDA) and protein carbonyls (PC) plasma concentrations are commonly used as valid biomarkers of oxidative stress [14,15]. Smoking cessation represents an essential component of both primary and secondary prevention of cardiovascular diseases [16,17]. In this respect, nicotine replacement therapy (NRT) and varenicline remain the mainstay of pharmacological smoking cessation interventions.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgment in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.
The disclosure information of the authors and reviewers is available from the CCS on the following websites:www.ccs.caand www.ccsguidelineprograms.ca.