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INTRODUCTION

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The reductions in cigarette smoking prevalence over the second half of the 20th century and beginning of the 21st century represent one of the major medical and public health advancements of this time. Decreases in smoking rates, in conjunction with improvement in treatment of other cardiovascular risk factors such high cholesterol and blood pressure and advancements in the treatment of heart disease, have contributed to substantial declines in rates of death from heart disease.1,2 Despite this progress, tobacco use remains a major preventable cause of morbidity and mortality worldwide. Both active smoking and passive exposure to secondhand smoke increase the risk of cardiovascular disease, malignancy, and pulmonary diseases. As a result, effective strategies for reducing health risks from smoking should address both smoking cessation and reduction of exposure to secondhand smoke.

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SMOKING CESSATION AMONG CURRENT SMOKERS

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Smoking cessation is an important component of both primary prevention and secondary prevention of cardiovascular disease. Despite this and the US Public Health Service recommendation that all patients be asked about their tobacco use status on a regular basis,3 tobacco use screening occurs in only two-thirds of outpatient physician office visits.4 Even though 69% of smokers are interested in quitting and over half report having made a quit attempt in the past year,5 only 21% of adult current tobacco users received tobacco cessation counseling and 8% received tobacco cessation medication during outpatient visits.4 This situation highlights the importance of screening by health professionals to capture individuals interested in tobacco cessation and assist them in quitting. This screening is particularly important because physician advice to quit smoking is associated with increased smoking cessation compared to no advice to quit or usual care, with higher cessation seen with more intensive advice compared to minimal advice.6 Interventions led by other members of the health care team, such as nurses, have also been associated with increased smoking cessation.7 It is important that screening be incorporated into all clinical encounters, including by cardiologists and other specialists, not only to identify and assist patients who are ready to stop smoking, but also to encourage those who are not yet ready to move toward making the decision to quit.

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Overall and Cardiovascular Benefits of Smoking Cessation

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The risk of overall mortality is greatly reduced for patients who quit smoking.8,9 Smoking cessation before the age of 30 years eliminates nearly all of the risk of death from smoking-related disease, and even those who quit when they are older gain years of life compared to those who continue to smoke.10,11 This fact highlights both the importance of encouraging smokers to quit early as well as encouraging quitting among all smokers, no matter how old they are.

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In addition to contributing to long-term development of atherosclerosis, smoking (and secondhand smoke exposure) has immediate effects ...

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