A study led by Dr. Mark Eisenberg, a cardiologist and epidemiologist at the Lady Davis Institute at the Jewish General Hospital, reveals that two-thirds of middle-age smokers who have been hospitalized for myocardial infarction—a heart attack—return to smoking a year later, despite having been treated with buprion (marketed as Wellbutrin for depression and Zyban for smoking cessation).

Though the drug has improved abstinence rates in younger healthier patients, it was not more effective than a placebo in older patients following a heart attack.

Though this finding implies that even critical illness and treatment with medication will not cure an embedded smoking addiction, Eisenberg puts a more positive spin on the study. “While two-thirds have gone back to smoking one year after their heart attack, one-third have quit and one-third have substantially cut down.”

The study used a randomized sample of 392 patients, whose median age was 54 and who smoked an average of 23 cigarettes per day. Persistent smokers in the study reduced their daily consumption to an average of eight per day with no difference between the Zyban group and the placebo group. Though quitting completely is the ideal, smokers who manage to reduce their consumption should continue in their efforts, Eisenberg says. “You should expect to slip up. It is very unusual to see people throw their cigarettes away and that’s it.” The fact that the subjects were older made quitting more difficult, Eisenberg said, as they had been smoking for three decades. “It’s very hard to break a habit like that even with meds.”

But Mark Twain’s advice about quitting smoking—that it’s easy to quit, since he had done it hundreds of times—was actually good advice, it seems.

Those who have significantly cut down on smoking could effectively be retargeted for smoking cessation therapy, Eisenberg said. Some smoking cessation programs enlist the family’s help. A third of the subjects in this study were living with other smokers, though this did not seem to make a big impact in terms of predicting quitting rates. Experts say that a multifactorial approach to quitting smoking is best and Eisenberg advises those wanting to quit to go to their family doctor to get a referral to a smoking cessation clinic.

Support includes group meetings where patients discuss issues surrounding smoking, how to deal with stress and other triggers to smoking. Medications may have such side effects as nausea or lowering the seizure threshold in people with epilepsy or severe head trauma, and are not indicated if less than 10 cigarettes a day are consumed, Eisenberg said. However, if necessary, a physician at the clinic can prescribe a medication. “While any reduction is positive, the health benefits of complete abstinence are significantly higher than even modest smoking. However, there is no escaping the power of a nicotine addiction combined with the social and behavioural aspects of smoking. It is very tough to quit and there is no magic bullet, in the form of a pill, that will make quitting easy.”

Health Canada estimates that 100 Canadians die a day from smoking-related illness.

Health Canada’s Pan Canadian Quit Line: 1-866-366-3667.