6533b86efe1ef96bd12cc46d

RESEARCH PRODUCT

Predictors of smoking cessation among smokers with cardiovascular diseases and risks factors in the French smoking cessation services national database CDTnet (STABA-CV)

subject

description

Background: Smoking represents a major modifiable risk factor for cardiovascular diseases (CVD), particularly in women. The smoking prevalence in France is among the highest in Europe, and the identification of factors associated with smoking cessation in high-risk CV populations remains poorly studied, specifically when potential sex-disparities might exist. The objective of this work was firstly to describe the current state of knowledge on the association between tobacco consumption and CVD risk in women, through a literature review. Then, using the French national smoking cessation consultations database - CDTnet, to describe the socio-demographic profile, medical profile and smoking behaviour of the smokers visiting smoking cessation services as well as to look for the predictive factors of smoking cessation and their disparities according to sex.Methods: For the review, we analysed the publications on the topic of epidemiology of smoking among women and the association between smoking and the incidence of CVD. Papers registered between 2000 and 2020 in the international bibliographic database Medline and the Bulletin Epidémiologique Hebdomadaire for the French data were selected. In the second part of the thesis, smokers >18 years of age with at least one CV risk (CVD risk factor or CVD) included in the CDTnet database between 2001 and 2018 were analysed. Abstinence was defined as self-reported smoking cessation of at least 28 consecutive days and confirmed by exhaled carbon monoxide <10 ppm.Results: Our review of the literature showed that compared with men, female smokers, whose prevalence continues to increase in France in certain age groups, have an increased and specific CV risk, linked in particular to the use of oestrogen-progestin contraceptives. In women, pharmacological and nonpharmacological smoking cessation treatments have been proved to be effective in reducing CV risk, regardless of the years of tobacco exposure, in primary as well as in secondary prevention. Of the 36 864 adult smokers with CV risk factors or CVD included in CDTnet, 42% were women. Compared with men, women were 3 years younger (48 vs 51 years, p<0.001), had a higher level of education and fewer risk CV factors and CVD history. Nevertheless, they were more likely to suffer from obesity, respiratory diseases and anxiety-depressive symptoms. Although women were less dependent on nicotine, their abstinence rate was paradoxically lower than that of men (52.6% vs 55.2%, p<0.001). We identified significant gender disparities in factors associated with abstinence. Factors negatively associated in women who smoked (but not in male smokers) were obesity and alcohol use disorder. Among men who smoked, but not among female smokers, the factors negatively associated were cannabis use, and certain comorbidities (peripheral arterial disease and tobacco related cancer). Our data from a prospective study on a large national base of smoking cessation consultations reinforce the definition of smoking cessation as a priority goal in subjects with CV factors or CVD history and suggest the necessity, in this high-risk population, of a gender-specific smoking cessation management.