To the Editor.—In demonstrating the cost-effectiveness
of AHCPR guidelines for smoking cessation, Dr Cromwell and colleagues1 provide yet another weapon in the arsenal of the
health practitioner to combat smoking. However, the authors' statement, "Even
when cessation leads to health benefits, these benefits are delayed many years,"
was both disappointing and incorrect.
Several studies have demonstrated a very early health benefit in reducing
the leading cause of death in this country, coronary artery disease. Rosenberg
and colleagues2 reported that in male smokers
younger than 55 years nearly half the excess risk of nonfatal myocardial infarction
attributable to cigarette smoking is eliminated after quitting for 1 year,
with the relative risk nearly 1.0 within 3 years of quitting. Similar results
have been demonstrated in women.3 In a population-based
case-control study, Dobson and colleagues4
reported the risk of a coronary event (including myocardial infarction and
coronary heart disease death) in former smokers declines rapidly after quitting
and within 2 to 3 years is similar to the risk of nonsmokers. Lightwood and
Glantz5 estimated that 924 fewer hospitalizations
for acute myocardial infarction would occur within the first year of a 1%
reduction in smoking prevalence, resulting in an immediate savings of $44
million.