Smokers and Postcessation Weight Gain After Acute Coronary Syndrome

J Am Heart Assoc. 2017 Apr 18;6(4):e004785. doi: 10.1161/JAHA.116.004785.


Background: Smoking cessation and weight management are recommended after acute coronary syndrome (ACS); however, little is known about the effects of smoking cessation on weight change after ACS. We aimed to assess the effect of smoking cessation after ACS on weight over a 12-month follow-up period.

Methods and results: Data were prospectively collected from the EVITA (Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome) trial. Weight change was compared among 3 groups of patients: those who were completely abstinent (n=70), those who smoked intermittently (n=68), and those who smoked persistently (n=34). Patients' mean baseline weight was 83.9 kg (SD 17.7) with a mean body mass index of 28.5 (SD 5.4). Patients smoked a mean of 37.7 years (SD 17.7) and a mean of 21.0 cigarettes (SD 9.0) per day prior to their ACS. Weight change varied across groups, with abstainers gaining a mean of 4.8 kg (SD 8.6), intermittent smokers gaining a mean of 2.0 kg (SD 8.9) and persistent smokers losing a mean of 0.7 kg (SD 7.4). At 52 weeks, abstainers were more likely to gain weight than persistent smokers (difference in means 5.5 kg; 95% CI 2.3-8.8). This weight gain was not associated with an increase in the use of antihypertensive or antidiabetic medications.

Conclusions: Following an ACS, significant weight is gained by patients who quit smoking. Weight-management interventions among smokers who quit after ACS should be a focus of investigation in future research so that the cardiovascular benefits achieved by smoking cessation are not offset by weight gain in this high-risk population.

Clinical trial registration: URL: Unique identifier: NCT00794573.

Keywords: acute coronary syndrome; secondary prevention; smoking; weight gain.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Blood Pressure
  • Body Mass Index
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotinic Agonists / administration & dosage*
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Risk Reduction Behavior*
  • Smoking / adverse effects
  • Smoking Cessation / methods*
  • Smoking Prevention*
  • Time Factors
  • Tobacco Use Cessation Devices
  • Treatment Outcome
  • Varenicline / administration & dosage*
  • Weight Gain*


  • Nicotinic Agonists
  • Varenicline

Associated data