Smoking cessation strategies in patients with peripheral arterial disease: an evidence-based approach

INTRODUCTION: Smoking is the single most important aetiological factor for the development and progression of atherosclerosis. Unfortunately, most patients receive little or no treatment for their nicotine addiction. This review aims to make evidence based recommendations for smoking cessation as part of a comprehensive delivery of best medical therapy to patients with peripheral arterial disease. METHODS: A search of MEDLINE (1966 to 2003) and the Cochrane library was undertaken for studies relating to smoking cessation. Major priority was given to meta-analyses of randomised controlled trials including Cochrane reviews. RESULTS: Physician advise, nicotine replacement therapy and Bupropion are all evidence based treatments that have success in increasing the likelihood of permanent smoking cessation. A basic understanding of the psychology of addictive behaviour is essential so that appropriate advice and treatment can be tailored to individual patients. CONCLUSIONS: Complete and permanent smoking cessation is by far the most clinically and cost effective intervention in patients with atherosclerosis. Greater awareness of smoking cessation strategies, by clinicians treating vascular patients, is essential for the effective delivery of best medical therapy.