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Cigarette smoking and acute coronary syndromes:
A multinational observational study


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June 20, 2005 - New study financed by Big Pharma says that smoking reduces morbidity and mortality from heart attacks and other cardiovascular disease – If this study yielded the opposite results it would have been all over the papers throughout the world; but, of course, we know damn well that informing the public about truths contradicting the myth that smoking-is-bad-for-you-no-matter-what has become one of the most absolute political taboos. Nevertheless, this study deserves special attention for a variety or reasons that we are about to examine.

First of all, the funding source – Important, since today the idiotic notion prevails that credibility is no longer a function of quality, truth and professionalism but only of the source of funding. Here the financer is the pharmaceutical multinational Aventis, which clearly got a “backfire” from the data, and thus wisely decided to snub the study because of probable adverse effects on the sales of smoking cessation “therapies”.

Second, the results: even those who want to deny (in full contradiction with the study’s data) that smoking has protective effects against cardiovascular disease now can no longer claim that smoking constitutes an aggravation. Furthermore, if that applies to active smoking, what might the implications be for passive smoking?  Why then are prohibitions on smoking in enclosed environments presented as “protection” for non smokers? But, hey -  just a moment… aren’t the health “authorities” telling us that smoking causes cardiovascular disease? In many countries it’s even mandatory to print that on cigarette packs!

Third, the false representation of the conclusions. The study – which is not case-control junk science based on questionnaires such as those on passive smoking, but an observational cross-sectional study of over 19,000 patients to which 94 hospitals in 14 nations have contributed (see second page of the study, “Materials and Methods”), talks about the “smokers’ paradox”. The paradox consists in this: since we “know” that smoking damages your health (real science aside, that is), how come so many studies (including the huge MONICA conduced by the World Health Organization, and others mentioned by this study in references number 2, 10, 11, 20) show that the general health conditions of smokers is overall better than those of non smokers, and by far better than those of former smokers? The peculiarity of this study is that, whilst the abstract concludes that the paradox does not exist, [*] its own figures and conclusions contradict the statement; but we all know quite well that, at best, journalists and reporters never read beyond the abstract…   but we do!

Let us examine Table 1 at page 111, which reports the data registered at the time of hospital admission:

Ailment Number of cases /Percentage of smokers with the ailment Number of cases /Percentage of former smokers with the ailment Number of cases /Percentage of non smokers with the ailment
     
lowest middle highest
Angina 2915 / (55.6%) 3977 / (70.3%) 5352 / (64.2%)
Myocardial infarction 1228 / (23.4%) 2289 / (40.4%) 2434 / (29.2%)
Hypertension  (high blood pressure) 2411 / (45.9%) 3496 / (61.8%) 5409 / (65.0%)
Diabetes 822 / (15.7%) 1474 / (26.0%) 2379 / (28.5%)
Hyperlipidaemia (excess fat in blood), hence risk of cardiovascular disease 2144 / (40.9%) 2904 / (51.6%) 3543 / (42.7%)

Why cholesterol, which is the “classic of the classics” risk for heart disease, is not reported in the study is a mystery – unless it turned out that it is so low in smokers that it would look too bad to report – especially considering that antismoking propaganda goes out of its way to persuade people of the “causality” of smoking in the obstruction of  arteries. Please note the striking difference between the “attributions” of epidemiological junk science trumpeted by antismoking cons and the practical reality observed in the hospitals whose doctors – by God – must tell us to quit smoking!

In Table 4 below (page 113 in the study) the outcomes of the hospital treatments for the most severe cases as defined on the basis of the cardiograms characteristics are reported:

Ailment Number of cases /Percentage of smokers with the ailment Number of cases /Percentage of former smokers with the ailment Number of cases /Percentage of non smokers with the ailment
     
lowest middle highest
Angina 1045 / (43.3%) 814 / (52.6%) 1154 / (45.9%)
Myocardial infarction 358 / (14.8%) 407 / (26.2%) 467 / (18.6%)
Hypertension  (high blood pressure) 968 / (40.1%) 829 / (53.5%) 1435 / (57.9%)
Diabetes 328 / (13.6%) 354 / (22.8%) 673 / (26.8%)
Hyperlipidaemia (excess fat in blood), hence risk of cardiovascular disease 823 / (34.1%) 663 / (42.9%) 854 / (34.1%)
Chronic heart failure 60 / (2.5%) 125 / (8.1%) 200 / (8.0%)
Stroke 35 / (1.5%) 16 / (1.0%) 57 / (2.3%)
Major bleeding 86 / (3.6%) 78 / (5.1%) 135 / (5.4%)
Mortality 92 / (3.8%) 103 / (6.7%) 295 / (11.8%)


Then, in section 4.2 (Discussion, page 114) we read: “A consistent finding in the GRACE population is the  lower risk profile of current smokers compared with former  smokers and non-smokers. This was also observed in most previous large-scale studies […], in which the lower risk profile accounted for much of the seemingly improved outcome of smokers compared with former smokers and non-smokers.”

The authors argue that the benefits observed in smokers may be due to their age, which is lower than other groups - but those benefits persist even after adjusting for age, as shown in Table 3 at page 112, where the advantage of smokers persevere even when it comes to mortality, which is the supreme index of success. In fact, at page 116, paragraph 4.6 (Conclusions) we read: “These data confirm that current smokers admitted with acute coronary syndromes have a more favourable risk profile and are more aggressively treated than the other smoking groups , whatever the mode of presentation of acute coronary syndromes … “

In spite of what the authors argue, therefore, the smokers’ paradox exists – and to quite an extent! But God forbid that we talk about it…

In summation, only one very important and interesting conclusion can be reached: even for cardiovascular disease, smokers seem to enjoy better health than non smokers, which in turn enjoy better health than former smokers, as demonstrated in this and other studies this work refers to in the References.

Two considerations, therefore, come to mind: the revisiting of the senseless belief that “smoking is bad for you” (without ever asking how much smoking, for the belief must be absolute), and the real value for health of quitting smoking. From the data on this and other studies it is apparent that quitting smoking may be even worse than not starting.  

It really seems that the only thing to really quit is giving false and biased information to the publicespecially when it comes  from public institutions; and, perhaps, the only real paradox is the romantic and brainless belief that “smoking is bad for you, no matter what”.

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* with these words: “There is no survival advantage related to current or prior cigarette smoking in patients admitted with acute coronary syndromes, regardless of presentation. In this large multinational registry, the smokers’ paradox does not exist.”. These, however, are not the conclusions of the chapter “Conclusions” at page 116. [return]

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