The recent report of the BIP (Bezafibrate Infarction Prevention) Study Group that cigarette smoking is a powerful independent predictor of sudden cardiac death risk in patients with coronary artery disease1 is extremely important from the public health point of view. Cigarette smokers are addicts (addiction to nicotine in the cigarettes) and therefore usually have a staunch and recalcitrant personality.
We have all seen cigarette smokers quit smoking during their stay in the coronary care unit of a hospital for their acute myocardial infarction and swear that they will never smoke again (they are prohibited from smoking anyway because of the oxygen tent), only to resume smoking the moment they are out of the coronary care unit. We have all witnessed the ugly sights of well-dressed men and women smoking in the streets beyond 50 feet of their office building in the chilly wintry weather, looking like vagabonds and street walkers. We have all seen these same people continue to huff and puff on their cigarettes despite their incessant coughs ("cigarette-induced coughs can loosen up phlegm"2). We have all seen cigarette smokers continue to smoke despite being diagnosed as having lung cancer and angina because lung cancer can be palliatively treated with chemotherapy and irradiation and angina by angioplasty and coronary bypass surgery. These diseases cause slow death, and thus there is time for these people to prepare for their eventual, though inevitable, demise. Sometimes I wonder if health care professionals are not doing more to help people stop smoking so that they can continue to make money treating the diseases caused by smoking.
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