The following are key points to remember from the 2018 American College of Cardiology (ACC) Expert Consensus Decision Pathway on Tobacco Cessation Treatment:

1. An estimated 6 million deaths each year are attributable to tobacco use. In particular, cigarette smoking carries the highest risk for cardiovascular disease (CVD) events. Although tobacco use has been in decline over the past several decades, an estimated 30 million people in the United States currently smoke.
2. Those who do not smoke but are exposed to second-hand smoke are at a 25-30% increased risk for CVD events, which translates into an estimated 33,000 deaths from heart disease each year. Smoke-free policies have reduced exposure to second-hand smoking in public areas; however, most of the second-hand smoking exposure is in the home. Providers are recommended to assess nonsmoking patients for exposure to second-hand smoke.
3. All smokers, regardless of duration and intensity of smoking, can benefit from smoking cessation. No one is too old to not benefit from quitting. Even those with established CVD can experience health benefits associated with smoking cessation.
4. Providers are key to assisting patients who smoke to quit. They should ask all patients about tobacco use, advise smokers to quit, assess a smoker’s readiness to quit, and assist smokers to quit. Hospitals are recommended to assess smoking status in all admitted patients, offer treatment to hospitalized smokers, and provide treatment at time of discharge.
5. Current evidence suggests the combination of pharmacotherapy (i.e., nicotine replacement, bupropion, and varenicline) with behavioral interventions (i.e., cognitive behavior therapy, motivational interviewing) are most effective for smoking cessation. Tobacco cessation programs are cost-effective. E-cigarettes may reduce cigarette smoking among current smokers; however, the long-term risk of e-cigarettes is not known. Ultimately, cessation of all combustible tobacco products is recommended.

Clinical Topics: Cardiovascular Care Team, Prevention, Smoking

Keywords: Atherosclerosis, Behavior Therapy, Bupropion, Drug Therapy, Life Style, Nicotine, Primary Prevention, Risk Reduction Behavior, Safety, Secondary Prevention, Smoking, Smoking Cessation, Tobacco, Tobacco Products, Tobacco Use, Tobacco Use Cessation

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