Motivation for Smoking Cessation

Studies have demonstrated that measuring peripheral atherosclerosis can improve risk prediction for cardiovascular disease and events; however, according to researchers, there have been very few randomized controlled trials (RCTs) to assess the clinical impact of atherosclerosis screening. Observational studies have suggested an association between patients knowing the results of screening for peripheral atherosclerosis and being motivated to alter behaviors such as increasing adherence to medications and making beneficial changes in lifestyle. However, the researchers add that these observational studies suffer from a lack of comparison with RCTs and the role of screening for atherosclerosis in clinical settings remains controversial. Recommendations are often in conflict, with some calling for screening only in certain subgroups and others advising screening for all patients. Noting that many smokers stop only after an acute cardiovascular event, the researchers hypothesized that knowledge of plaque-screening results would encourage patients to adhere to their medication regimen, make lifestyle changes, and subsequently see improvement in cardiovascular risk factors. To determine if carotid plaque screening represents a “teachable moment similar to acute cardiovascular events,” the researchers conducted a study to assess whether screening for carotid plaque helps motivate smokers to stop smoking and improve other cardiovascular risk factors. They reported study results in Archives of Internal Medicine [2012;172(4):344-352]. Outcome measures included biochemically validated smoking cessation at 12 months and changes in cardiovascular risk factor levels and Framingham risk score. The study included 536 smokers who received individual counseling and nicotine replacement therapy. Participants were randomized to a carotid plaque ultrasonographic screening group (US, n=267) or to a no-screening group (control, n=269). Smokers with at least 1 plaque received pictures of their plaques along with a 7-minute structured explanation. At baseline, the mean age of participants was 51.1 years and 45.0% were women. They smoked an average of 20 cigarettes per day and had been smoking for an average duration of 31.7 years. In the US group, 57.9% had a high prevalence of carotid plaques. Most of the participants (n=461) intended to stop smoking within 30 days, 65 intended to stop within 6 months, 8 were trying to stop, and 2 were indeterminate. At the 12-month mark, smoking cessation rates were >20% in both groups, but there were no significant differences between the 2 groups (24.9% in the US group vs 22.1% in the control group; P=.45). Cessation rates did not differ according to the presence or absence of plaques in the US group; in addition, control of cardiovascular risk factors (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 in Framingham risk score was +0.6 in the US group compared with +0.3 in the control group, P=.56.