Smoking cessation more likely to improve mood in heart attack survivors

Smokers with depression at the time of a heart attack who quit smoking are more likely to improve their mood than those who continue the habit. That's the finding of research presented at ESC Congress 2021.

Smoking and depression often go hand-in-hand, and both are considered risk factors for a heart attack. This study examined whether depressed patients who quit smoking after a heart attack have an improvement in their mental health compared to those who continue smoking.

The study enrolled 1,822 acute coronary syndrome patients from the Swiss SPUM-ACS cohort. Acute coronary syndrome included both heart attacks and unstable angina.

Smoking status was assessed via questionnaire at the time of hospitalization for acute coronary syndrome and one year later. At one year, smoking status was confirmed with a carbon monoxide breath analysis. A total of 1,076 patients were non-smokers at the time of hospitalization and one year after. Therefore, the authors divided the remaining 746 smokers into "continuous smokers" (392 patients smoking at the time of hospitalization and one year later, 21.5%) and "quitters" (354 patients who stopped smoking during the year after the heart event, 19.4%).

Depression was assessed using the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. Participants were classified as "depressed" or "not depressed" at baseline and one year. At baseline, 411 (22.6%) patients were depressed and 1411 (77.4%) were not depressed. At one year, 461 (25.3%) patients were depressed and 1361 (74.7%) were not depressed.

The researchers analyzed the associations between smoking and depression after adjusting for age, sex, body mass index, education, marital status, physical activity, alcohol use, diabetes, history of cardiovascular disease, cardiac rehabilitation attendance, and high-dose statins at discharge.

The analysis was conducted in the 411 smokers who were depressed at the time of hospitalization. The researchers examined whether those who quit in the following year were more likely to improve their depressive symptoms in comparison to those who continued smoking. Compared to smokers who continued the habit in the year after their heart event, those who quit smoking were more likely to see an improvement in their depressive symptoms and be classified as "not depressed" (adjusted odds ratio 2.10; 95% CI 1.07-4.09).

Previous research has shown that smoking cessation is associated with mental health benefits and our study extends this pattern to heart attack survivors. We hope the findings will encourage smokers who have suffered a heart attack to kick the habit."

Ms. Kristina Krasieva, study author, medical student at the University of Lausanne, Switzerland