If you were a smoker, would you quit smoking if you had heart problems and your doctor told you to stop smoking?

Many European heart patients facing that situation kept on smoking, researchers report in the European Heart Journal.

They surveyed more than 5,500 heart patients between 1999 and 2000. About 2,200 had been smokers before being hospitalized for heart problems.

Although virtually all of the smokers (99 percent) reported being told by a doctor to quit smoking, less than half (48 percent) had done so.

Smoking is well known for raising the risk of many health problems, including heart disease and cancer, which are leading causes of death for both men and women.

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Shocked Scientist Reacts

The finding was “unbelievable,” says researcher Wilma Scholte op Reimer, in a news release. She works in the cardiology department of Erasmus Medical Center in Rotterdam, Netherlands.

“It makes me wonder if they are truly aware of the risk that they are taking,” op Reimer says.

The results were about the same as when the study was done five years earlier. The lack of improvement is “disappointing,” op Reimer says.

She and her colleagues call for more work to drive the message home -- and to help smokers quit smoking.

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Study’s Design

The study included more than 5,500 people in 15 European countries who were less than 70 yeas old.

The patients had been hospitalized for heart attacks, balloon angioplasty to reopen arteries, coronary bypass grafts, or pain from insufficient blood flow to the heart (myocardial ischemia).

About 18 months later, they were interviewed about topics including whether they smoked cigarettes, cigars, or pipes.

Just in case anyone fudged, those who claimed to have quit smoking after heart hospitalization took a breath test to check for traces of carbon monoxide. Only those who passed the test were considered “stopped smokers.”

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Who Quit Smoking, Who Didn’t

Those smokers that quit were found to more likely be older, more educated, had had a heart attack, obese patients, and those still under the care of a cardiologist.

No big differences were seen in the percentages of men and women who quit smoking.

One other trend stood out. It concerned the way doctors delivered their quit-smoking message.

Written Orders Often Ignored

Some patients said their doctors put their orders in writing. They included 20 percent of the people who stopped smoking after heart hospitalization -- and 30 percent of persistent smokers.

“We can’t tell from our study why this is,” says op Reimer.

In Denial?

Some patients may have mistakenly thought that anything short of a heart attack wasn’t that threatening.

Nothing could be further from the truth, the researchers note.

For instance, the long-term risk of death after myocardial ischemia is “no better than that of patients who have had a heart attack,” says op Reimer in the news release.

“Perhaps this needs to be spelled out to them,” she says.

Five Steps to a Healthier Heart

Doing Something Right

Quitting smoking can be very tough. It can also be challenging to build other heart-friendly habits, such as upgrading diet and exercise.

But those changes are possible. Just look at the participants who quit smoking after hospitalization.

They beat persistent smokers at cutting intake of fat, salt, and calories while boosting physical exercise and consumption of fish and vegetables, the study shows.

That’s based on the patients’ interviews. Those claims weren’t confirmed.

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Major Motivation

“Making lifestyle changes is a complex and difficult process from [a] psychological point of view, and evidence exists that only those who are really motivated succeed,” the researchers write.

“Indeed, our data demonstrated that patients who gave up smoking also took significantly more actions to improve their lifestyle otherwise than persistent smokers,” they continue, noting that tackling more than one preventable risk factor at a time seemed to work best in their study.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: op Reimer, W. European Heart Journal, Oct. 6, 2005. News release, MW Communications.