TOBACCO REDUCTION STRATEGIES FOR PATIENTS WITH CARDIAC DISEASE

吸烟会促进动脉粥样硬化性心血管疾病（ASCVD），戒烟对心脏病患者的健康有显著的益处。完全戒烟是目前烟草依赖治疗模式的目标，但许多患者无法获得。吸烟量与ASCVD风险之间存在强烈的剂量反应关系，这表明对于那些无法戒烟的患者，减少吸烟可能是有益的。尼古丁替代疗法（NRT）在心血管疾病患者中是安全的，有限的数据表明长期NRT可有效减少烟草使用和一氧化碳（CO）暴露。我们提出了一项在180例ASCVD患者中进行的随机对照临床试验，以检验以下假设：旨在减少吸烟至少50%的联合行为和药物干预将1）减少卷烟消费，2）提高戒烟率，3）减少ASCVD的体征和症状，4）改善ASCVD的风险因素，和5）就所获得的每质量调整寿命年的成本而言，证明是具有成本效益的。我们将从两个门诊护理中心随机将受试者分配到减少吸烟治疗（SR）组（包括标准化的尼古丁透皮给药方法，或如果使用贴剂未能成功减少吸烟，则使用尼古丁口香糖）或对照组。受试者将接受为期两年的随访，如果他们准备好了，将鼓励他们随时退出。我们将收集有关吸烟行为、运动耐量、心绞痛、生活质量和不良事件的数据;并测量尼古丁、可替宁、CO、脂质和纤维蛋白原。我们将为生物标志物核心项目提供样本，以评估减少吸烟对其他毒素水平的影响。我们将对这种做法的潜在成本效益进行经济分析。这项研究将测试在医学疾病人群中减少卷烟消费的长期策略是否安全，有效，并改善无法戒烟的吸烟者的健康结果。

Cigarette smoking promotes atherosclerosclerotic cardiovascular disease (ASCVD), and cessation confers significant health benefits to patients with heart disease. Total abstinence is the goal of current tobacco dependence treatment models, however, it is not accessible to many patients. There is a strong dose-response relationship between the amount smoked and risk for ASCVD, suggesting that for those patients who cannot stop, reducing smoking may be of benefit. Nicotine replacement therapy (NRT) is safe in patients with cardiovascular disease, and limited data suggest that long term NRT is effective at reducing tobacco use and carbon monoxide (CO) exposure. We propose a randomized controlled clinical trial in 180 patients with ASCVD to test the hypothesis that a combined behavioral and pharmacological intervention designed to reduce smoking by at least 50% will 1) reduce cigarette consumption, 2) improve smoking cessation rates, 3) reduce signs and symptoms of ASCVD, 4) improve risk factors for ASCVD, and 5) prove to be cost-effective in terms of cost per quality adjusted life year gained. We will randomly assign subjects from two ambulatory care sites to the smoking reduction treatment (SR) group (including a standardized approach to transdermal nicotine, or nicotine gum if not successful reducing using patch) or the control group. Subjects will be followed for a two year period, and will be encouraged to quit at any time if they are ready. We will collect data regarding smoking behavior, exercise tolerance, angina, quality of life, and adverse events; and measure nicotine, cotinine, CO, lipids, and fibrinogen. We will contribute samples to the Biomarker Core project to assess the effect of smoking reduction on other toxin levels. We will conduct an economic analysis of the potential cost-effectiveness of this approach. This study will test whether a long term strategy to reduce cigarette consumption in a medically ill population is safe, effective , and improves health outcomes for smokers who cannot quit.