Study: Most women need help to kick smoking habit

Women who smoke — the single biggest risk factor for heart disease and lung cancer — are likely to need help from drugs and nicotine replacement therapy to kick the habit, researchers said this week.

A STUDY conducted at the University of California at San Francisco looked at why women who ended up in the hospital with cardiovascular disease continued to smoke.
All 277 women in the study were smokers, at an average age just over 61 years, who said they were willing to quit. The women were also mostly Caucasian, quite ill, had smoked for about 40 years and were highly addicted to tobacco, Erika Froelicher, professor at UCSF’s School of Nursing and Medicine, said at a meeting of the American Heart Association in Anaheim, Calif.
Researchers also found that nearly 57 percent of the women were depressed based on a commonly used index. Forty percent of the women studied were married.
“Smoking acts as an antidepressant. A lot of women self-medicate for depression by smoking,” Froelicher said.
She also said women may be more prone than men to fear weight gain after quitting tobacco and are influenced by advertising. “Ads and even movies associate cigarettes with being cool. Until we have a campaign to counter that we have an uphill struggle,” the UCSF researcher said.
Another study presented at the conference looked at the effectiveness of Zyban, made by GlaxoSmithKline Plc which also markets the drug as an antidepressant under the brand name Wellbutrin. This trial of 629 heavy-smoking patients with heart disease found that 47 percent of patients given the drug for 7 weeks, along with motivational counseling, were able to quit tobacco, compared with 19 percent on placebo.
       
ZYBAN EFFECTIVE:

After 12 weeks, 34 percent of the Zyban group did not smoke, compared with 15 percent on placebo. The split narrowed to 27 percent and 11 percent at 26 weeks, according to Dr. Andre Perruchoud of University Hospital of Basel in Switzerland, the study’s lead investigator.
“The rate of abstinence was three times that of placebo,” he said. Perruchoud said Zyban, which inhibits the brain’s uptake of dopamine, works to combat depression in the same way smoking does.
Side effects of Zyban include insomnia and dry mouth, but the rate of withdrawal from the study due to these issues was about the same in both groups, 5 percent for Zyban patients and 6 percent for placebo. The researchers also found no increase in blood pressure from use of the drug in these heart patients.
Perruchoud noted that two tablets of Zyban cost about the same as a pack of cigarettes.

In a separate UCSF study of 127 female smokers, researchers discovered that nicotine replacement therapy is highly underused in women smokers with cardiovascular disease. Only 9 percent to 22 percent of women for whom nicotine therapy was indicated actually used it to quit smoking.
Until recently, federal government guidelines called for caution in use of nicotine replacement therapy in cardiac patients. The advice now is that the risk of nicotine replacement therapy outweighs the risk of continued smoking.
Froelicher said nicotine patches are probably a better bet than nicotine gum, which needs a slow release in the mouth in order for it to work. “Most gum chewers will just chomp away at them — the don’t get the slow release,” she said.

The researchers said recent data highlights the need for more education and counseling of highly-addicted women, including instruction in the use of smoking cessation aids.
Smoking tops the list of the Heart Association’s list of the six major modifiable habits that contribute to cardiovascular disease. The other five are high blood pressure, high blood lipids, inactivity, obesity and diabetes.
       
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