Bénéfices cardiovasculaires du sevrage tabagique

Environmentally Not So Friendly: Global Warming, Air Pollution, and Wildfires: JACC Focus Seminar, Part 1

Environmental stresses are increasingly recognized as significant risk factors for adverse health outcomes. In particular, various forms of pollution and climate change are playing a growing role in promoting noncommunicable diseases, especially cardiovascular disease. Given recent trends, global warming and air pollution are now associated with substantial cardiovascular morbidity and mortality. As a vicious cycle, global warming increases the occurrence, size, and severity of wildfires, which are significant sources of airborne particulate matter. Exposure to wildfire smoke is associated with cardiovascular disease, and these effects are underpinned by mechanisms that include oxidative stress, inflammation, impaired cardiac function, and proatherosclerotic effects in the circulation. In the first part of a 2-part series on pollution and cardiovascular disease, this review provides an overview of the impact of global warming and air pollution, and because of recent events and emerging trends specific attention is paid to air pollution caused by wildfires.

Update on new forms of tobacco use

Smoking remains the leading cause of morbidity and mortality worldwide. Because of its clear influence on cardiovascular and respiratory diseases, it is an important factor in internal medicine consultations. Although the rate of smoking cessation has been increasing in recent years, there is a percentage of patients who continue to smoke because they are unable or unwilling to quit, despite having tried existing pharmacological and non-pharmacological therapies. For this group of patients there are strategies based on interventions aimed at reducing the negative effects of smoking without the need for complete cessation. In this review it is shown that due to the absence of combustion of organic matter in conventional cigarettes, snus, e-cigarettes and heated tobacco products generate significantly lower levels of toxic substances.

[Proactive bedside counseling of smokers hospitalized in cardiac intensive care unit]

AIM OF THE STUDY

To offer routine information on smoking cessation and bedside counseling to smokers admitted in cardiac intensive care unit. The objective is to encourage cessation and/or use of smoking cessation services after discharge.

POPULATION AND METHODS

Thirty-three smokers were admitted in cardiac intensive care unit at the Georges Pompidou European hospital (HEGP) in Paris (France) from 1st March to June 30th 2010. Assessment of tobacco use and offer of counseling and follow-up visits during and after hospital stay. Evaluation of tobacco use by telephone at least six months after discharge.

RESULTS

It was found that 30.3% of the patients stopped smoking, mostly without specialized help despite heavy smoking prior to hospitalization. They declared being impressed by their hospital stay. Motives for smoking among continuing smokers were mostly automatic smoking and stress relief. They had declined any smoking aid, despite subsequent hospital stays in cardiac intensive care. Three smokers with a severe profile had died at follow-up. Smokers followed-up at HEGP were in need of nicotine replacement therapy. More than six months after hospital discharge, nearly all smokers remembered being offered bedside counseling to stop smoking.

CONCLUSION

This experience reveals the importance of routine bedside counseling for smoking cessation in cardiac intensive care unit. Smokers in this unit often continue smoking even though smoking hinders cardiac rehabilitation.