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Smoking Cessation Priority — EECC MCQ

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EasyGeneral CardiologySmoking Cessation PriorityEECC

A 45-year-old man is being assessed for cardiovascular screening. His father had an MI at age 52. He smokes 20 cigarettes/day, has a BMI of 30, BP 138/88, total cholesterol 6.5 mmol/L, and HbA1c 42 mmol/mol. According to ESC guidelines, which is the single most impactful risk factor to address?

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Correct answer: E — Smoking cessation — it provides the most immediate and substantial cardiovascular risk reduction of any single lifestyle intervention, approximately halving CVD risk within 1-2 years

While all cardiovascular risk factors should be addressed, smoking cessation provides the most rapid and dramatic risk reduction. The ESC 2021 Prevention Guidelines highlight that smoking cessation reduces CV mortality by approximately 36-50% within 1-2 years, with risk approaching that of never-smokers after 10-15 years. It is the single most cost-effective intervention in cardiovascular prevention. Pharmacological cessation aids (varenicline — most effective, NRT, bupropion) should be offered alongside behavioural support. Importantly, smoking doubles the risk of every cardiovascular event (MI, stroke, peripheral vascular disease, aortic aneurysm), and its effect is multiplicative with other risk factors.

Reference: ESC (2021): Guidelines on Cardiovascular Disease Prevention