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Viewing arterial plaque does not help smokers quit

Robin Wulffson MD's picture
atherosclerosis, plaques, carotid artery, stroke, smoking cessation, ultrasound

Smokers have an increased risk for atherosclerosis, which is manifested by fatty deposits in the areas. These narrowed arteries restrict blood flow, which can result in inadequate blood flow to the area they serve. They also can become completely blocked, which results in death of the cells. For example, a narrowing of the carotid artery, which connects the heart to the brain, can cause dizziness. If it is completely blocked, a stroke can occur.

Researchers at the University Hospital in Bern, Switzerland conducted a study in which smokers viewed ultrasound images of their carotid arteries. They wanted to determine if viewing the arteries would help them quit. Unfortunately it did not. Their results were published online on January 23 in the Archives of Internal Medicine.

The study group was comprised of 536 smokers aged 40 to 70 years who were randomly assigned to either a carotid plaque ultrasonographic screening or no screening (control group); both groups received individual counseling and nicotine replacement therapy. Smokers with at least one plaque received pictures of their plaques with a seven-minute structured explanation. Twelve months later, the participants were evaluated as to whether they had quit smoking; in addition, they were screened for changes in cardiovascular risk factor levels and the Framingham risk score.

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At baseline, the participants (average age 51.1 years; 45.0% women) smoked an average of 20 cigarettes per day with a median duration of 32 years. The ultrasound group had a high prevalence of carotid plaques (57.9%). At 12 months, smoking cessation rates were high; however, they did not differ between the ultrasound and control groups (24.9% vs. 22.1%). In the ultrasound group, cessation rates did not differ according to the presence or absence of plaques. In addition, control of cardiovascular risk factors (i.e., blood pressure and low-density lipoprotein cholesterol and hemoglobin A1c levels in diabetic patients) and mean absolute risk change in Framingham risk score did not differ between the groups. The mean absolute risk change in Framingham risk score was +0.6 in the US group vs. +0.3 in the control group.

The authors concluded that in smokers, carotid plaque screening performed in addition to thorough smoking cessation counseling was not associated with increased rates of smoking cessation or control of cardiovascular risk factors.

Last year, the Food and Drug Administration (FDA) announced a more graphic warning than viewing an ultrasound image; the agency made a requirement that tobacco companies place large graphic warning labels on cigarette packages by September 2012. The proposed labels included a number of graphic images, including staged photos of a corpse and of a man breathing smoke out of a tracheotomy hole in his neck. However, on November 7, 2011, in a preliminary injunction, Judge Richard J. Leon of United States District Court in Washington ruled that tobacco companies were likely to win a free speech challenge against the labels; he added that the labels were not factual and required the companies to use cigarette packages as billboards for what he described as the government’s “obvious anti-smoking agenda!” The ruling marked a setback for Congressional and FDA efforts to force the inclusion of the warnings on cigarette packages. The FDA claims that they are the most significant change to health warnings in 25 years.

Source: Archives of Internal Medicine

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