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t attack patients may be due to a lack of awareness of their risk, according to Dr Scholte op Reimer. A heart attack was often the first manifestation of coronary disease. Doctors were keen on achieving good risk management in these cases and the patients themselves were motivated because they probably realised the seriousness of their diseases.

However, for angina patients, the risk may have been under-estimated. "In fact, their long term mortality is no better than that of patients who have had a heart attack," she said. "Perhaps this needs to be spelled out to them. The need to stop is highest in patients with established coronary heart disease (CHD) as within 2-3 years the risk of subsequent events falls to that of CHD patients who have never smoked. In people with no symptoms it takes up to 10 years for risks to fall to the level of non-smokers. This shows how much a patient can gain from quitting often much more than most of the medication they take. I think professionals should confront their patients with these facts more often."

Another surprising finding was that only a fifth of those who had stopped reported having received written advice compared with 30% of those who continued smoking. "We can't tell from our study why this is," said Dr Scholte op Reimer. "Perhaps most patients that stopped had already made the decision when the written advice was given to them and therefore didn't register it, or maybe the advice was offered or put out for them to take away, but having decided to stop smoking, not accepted because they felt no need to take it."

The survey showed there was still a need for the development of more intensive, effective smoking cessation programmes, particularly focused on younger patients, those with lower levels of education (who the survey found were less likely to stop than those with university education) and those whose disease had first manifested as angina.

Dr Scholte op Reimer said that, in line
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Contact: Margaret Willson
m.willson@mwcommunications.org.uk
44-153-677-2181
European Society of Cardiology
5-Oct-2005

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