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Introduction: Attempts to quit smoking have increased in recent years, but the patterns of variations over time are unknown. We aimed at describing time- and sex-related changes in a population of 2,231 subjects who adhered to a smoking-cessation programme lasting 13 years in Italy. Methods: We measured baseline expired carbon monoxide (expired-CO), Fagerstrom nicotine dependence, Q-MAT test, Zung depression and anxiety scale, Hospital anxiety and depression scale (HADS). Results: Study population included 1,278 men and 953 women who smoked a median of 25 (interquartile range, IQR: 20–32) and 20 (IQR: 20–30) cigarettes/day, respectively (p < 0.001). The proportion of female smokers increased from 37.5% in 2001–2003 to 46.9% in 2010–2013 (p = 0.003). There was a significant time-related reduction of median daily cigarette consumption, with a more noticeable decrease in men. Median expired-CO (parts per million (ppm)) increased only in women, from 18 (IQR: 14–23) in 2001–03 to 20 (IQR: 14–28) in 2010–13 (p = 0.001), whereas Fagerstrom test for nicotine dependence did not vary. Differences in psychological characteristics in the last 3 years showed that women were more clinically depressed than men (16.6% versus 7.6%, p < 0.001). Conclusions: Despite a decrease in the number of daily cigarettes with time, expired-CO tends to increase in women, who are also more clinically depressed and anxious than men. A personalised approach to specific subgroups of smokers, with special emphasis on a psychological support for women, seems appropriate. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is the single most preventable cause of death. Its cessation is the most cost-effective strategy for reducing long-term cardiovascular morbidity and mortality. Although both healthcare professionals and the general population are aware of the detrimental effects of smoking on health, more than 25% of Italians are current smokers. Recent surveys showed that almost 50% of smoker patients relapse to smoke after having been discharged for acute coronary syndrome. Physicians who smoke may be a barrier for effective cessation interventions. Thus, it is important to assess cardiologists' attitude toward smoking habits and the implementation of smoking cessation programs., Methods: The survey "Italian cardiologists and smoking habits" has been held in 2013 during the 44° National Congress of the Italian Association of Hospital Cardiologists (ANMCO) to assess cardiologists' smoking status, their level of knowledge about smoking cessation interventions and their involvement in the management of smoking cessation. Out of more than 1200 cardiologists attending the ANMCO congress, 610 subjects (aged 51 ± 11 years) answered an anonymous 35-item questionnaire; they were asked to declare their smoking status (9.5% current smokers)., Results: Among doctors who attended the survey, 58% correctly indicated smoking as an addiction and 45% regularly advised their patients to stop smoking. The majority of cardiologists (93%) reported a positive attitude toward smoking cessation strategies, 62% of them thought that cardiologists themselves should treat smoking dependence, though specific tools (70%) and education for the management of smoking cessation are lacking (66%). Two thirds of the entire sample of ANMCO cardiologists declared their willingness to participate in specialized educational programs., Conclusions: More than a half of Italian cardiologists are aware that smoking is an addiction. Although they feel themselves yet inadequate toward this approach, they are favorable to implement their own knowledge and skills toward smoking cessation.

In recent years, a huge increase in the use of cardiac procedures, both invasive and non-invasive, was observed. Diagnostic tests, mainly non-invasive tests, are often prescribed inappropriately, in most cases replacing the clinical evaluation. The rate of inappropriate tests in cardiology is largely variable, depending on regional issues and different medical approach. When the test entails radiation exposure, the biological risk for both the patient and the environment must be taken into account. For this reason, the test that results in less biological risk should always be preferred as a first step.Moreover, it has not been clearly demonstrated that some diagnostic tests help to improve the outcome, that is to prevent cardiovascular events. As many as one sixth of the patients who undergo stress imaging are not taking proper medication, and very frequently no change in therapy is made after the test, regardless of the outcome. Since the appropriateness of diagnostic evaluation requests is mandatory, we focused on the diagnostic tests usually performed in primary and secondary prevention that carry no contribution to the clinical management of patients. This review addresses the need to optimize available resources, reduce costs and avoid unnecessary cardiovascular assessments, thereby enhancing the more efficient care delivery models.

Medical programs supporting smoking cessation are a complex task to set up. Each smoker should be evaluated for his stage of motivation to change, his nicotine dependence degree and also for the presence of relevant existing comorbidities. Several non pharmacologic techniques and a number of drugs have been demonstrated clearly effective in the smoking cessation therapy field. The purpose of this review is to analyse the available drug therapies mainly considering their possible use in the clinical cardiology "real world" scenario. Specific attention has been paid to the cardiovascular safety of each drug therapy trying to anticipate possible questions and concerns emerging in the daily practice of the clinical cardiologist, who normally can't be considered a smoking cessation "natural born" specialist.