THURSDAY, April 11, 2002 (HealthDayNews) -- Because smoking is considered slow-motion suicide, why do some people who have heart transplants continue to light up?
Carol Stilley doesn't have the answer yet, but she and her colleagues at the University of Pittsburgh took a big first step toward that end in a new study of 202 heart transplant recipients. They report their findings today at the annual meeting of the International Society for Heart and Lung Transplantation in Washington, D.C.
As might be expected, a large portion of the recipients -- 71 percent -- had been smokers before the surgery. The amount they smoked ranged from two to more than 95 pack years, which is the number of packs per day times years of smoking. While the overall rate of post-transplant smoking was 27 percent, all but one of the smokers were resuming a habit they had before the transplant. That one exception is a man who acknowledges having an occasional cigar.
One big reason for resuming the habit is nicotine addiction, Stilley says. "Smoking is highly addictive. The relapse rate in the general population is close to 90 percent."
However, that's just part of the answer, because "smoking is a complex behavior, involving social interactions, visual cues and other factors," Stilley explains.
Interviews with the patients, family members and nurses during the three-year study gave some strong predictors of a smoking relapse.
Those who clung to the cigarette habit until less than six months before the transplant were much more likely to resume smoking early and to smoke more. Depression and anxiety within two months after the transplant also made for an early relapse, and for heavy smoking. Having a caretaker who smoked was also a strong predictor.
Knowing about those risk factors could help develop strategies for identifying those in greatest need of early intervention, Stilley says. She cites European studies that show the five-year survival rate for post-transplant smokers is 37 percent, compared to 80 percent for nonsmoking recipients.
One reason for the shorter survival rate is that smokers can develop inoperable lung cancers within five years after a transplant, Stilley says. Also, "surgeons are noticing an alarming incidence of head and neck cancers in transplant recipients who resume smoking," she adds.
The recommendation for these smokers, she says, is not much different from the standard regimen: nicotine supplements and behavioral modification.
The study will continue, Stilly says, in hopes of getting more useful information: "The next step is to look at people in the study three years out -- those who have survived for three years."
What To Do
The knowledge that smokers find it difficult to stop smoking after an event as drastic as a heart transplant is an excellent incentive to never start the lethal habit.
You can learn more about smoking cessation strategies, programs and aids from the Centers for Disease Control and Prevention or the American Lung Association.
