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      Faible taux de succès du sevrage tabagique à court et moyen termes au décours d'un infarctus aigu du myocarde dans un service de cardiologie de Dakar au Sénégal Translated title: Low success rate of smoking cessation in the short to medium term at the waning of an acute myocardial infarction in a cardiology department in Dakar, Senegal

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          Abstract

          Introduction

          Le tabagisme est un puissant facteur de risque cardio-vasculaire. Son sevrage semble moins bien pris en compte chez les coronariens. Les objectifs de ce travail étaient d’évaluer la prévalence du tabagisme et le sevrage tabagique au décours d'un infarctus du myocarde dans un service de cardiologie au Sénégal.

          Méthodes

          Il s'agit d'une étude transversale et descriptive réalisée entre janvier 2008 et juin 2010. Nous avons recruté les patients hospitalisés pour infarctus du myocarde puis les fumeurs actifs ont été inclus dans notre enquête. Les malades étaient sensibilisés pour l'arrêt du tabac puis suivis à 3 mois, 6 mois et 12 mois pour évaluer le sevrage tabagique.

          Résultats

          Nous avons recensé 82 patients hospitalisés pour un infarctus du myocarde, parmi eux 26 sujets (25 hommes) étaient fumeurs (31,7%). L’âge moyen des sujets fumeurs était de 56±11,5 ans. La consommation moyenne de tabac était de 32±14 paquets-année et le score moyen de Fagerström de 8. Tous les patients ont arrêté le tabac pendant l'hospitalisation. Après un suivi de 3 mois, 45% des patients ont repris le tabac, 65% à 6 mois et 85% à 12 mois.

          Conclusion

          Le tabagisme est assez fréquent chez les patients sénégalais présentant un infarctus du myocarde. Le taux de sevrage tabagique à court et moyen termes est faible. Le sevrage tabagique devrait alors constituer un objectif privilégié dans la prévention des maladies cardio-vasculaires.

          Most cited references20

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          Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study.

          Cardiovascular disease (CVD) is rising in low-income countries. However, the impact of modifiable CVD risk factors on myocardial infarction (MI) has not been studied in sub-Saharan Africa (SSA). Therefore, we conducted a case-control study among patients with acute MI (AMI) in SSA to explore its association with known CVD risk factors. First-time AMI patients (n=578) were matched to 785 controls by age and sex in 9 SSA countries, with South Africa contributing approximately 80% of the participants. The relationships between risk factors and AMI were investigated in the African population and in 3 ethnic subgroups (black, colored, and European/other Africans) and compared with those found in the overall INTERHEART study. Relationships between common CVD risk factors and AMI were found to be similar to those in the overall INTERHEART study. Modeling of 5 risk factors (smoking history, diabetes history, hypertension history, abdominal obesity, and ratio of apolipoprotein B to apolipoprotein A-1) provided a population attributable risk of 89.2% for AMI. The risk for AMI increased with higher income and education in the black African group in contrast to findings in the other African groups. A history of hypertension revealed higher MI risk in the black African group than in the overall INTERHEART group. Known CVD risk factors account for approximately 90% of MI observed in African populations, which is consistent with the overall INTERHEART study. Contrasting gradients found in socioeconomic class, risk factor patterns, and AMI risk in the ethnic groups suggest that they are at different stages of the epidemiological transition.
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            Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme.

            (2001)
            The principal aim of the second EUROASPIRE survey was to determine in patients with established coronary heart disease whether the Joint European Societies' recommendations on coronary prevention are being followed in clinical practice. This survey was undertaken in 1999-2000 in 15 European countries: Belgium, Czech Republic, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Poland, Slovenia, Sweden, Spain and the U.K., in selected geographical areas and 47 centres. Consecutive patients, men and women or =140 mmHg and/or diastolic blood pressure > or =90 mmHg), 58% had elevated serum total cholesterol (total cholesterol > or =5 mmol x l(-1)) and 20% reported a medical history of diabetes. Glucose control in these diabetic patients was poor with 87% having plasma glucose >6.0 mmol x l(-1)and 72% > or =7.0 mmol x l(-1). Among the patients interviewed the use of prophylactic drug therapies on admission, at discharge and at interview was as follows: aspirin or other antiplatelets drugs 47%, 90% and 86%; beta-blockers 44%, 66% and 63%; ACE inhibitors 24%, 38% and 38%; and lipid-lowering drugs 26%, 43% and 61%, respectively. With the exception of antiplatelet drugs, wide variations in the use of prophylactic drug therapies exist between countries. This European survey of coronary patients shows a high prevalence of unhealthy lifestyles, modifiable risk factors and inadequate use of drug therapies to achieve blood pressure and lipid goals. There is considerable potential throughout Europe to raise the standard of preventive cardiology through more effective lifestyle intervention, control of other risk factors and optimal use of prophylactic drug therapies in order to reduce coronary morbidity and mortality. Copyright 2001 The European Society of Cardiology.
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              Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies.

              To determine the effect of smoking cessation on mortality after myocardial infarction. English- and non-English-language articles published from 1966 through 1996 retrieved using keyword searches of MEDLINE and EMBASE supplemented by letters to authors and searching bibliographies of reviews. Selection of relevant abstracts and articles was performed by 2 independent reviewers. Articles were chosen that reported the results of cohort studies examining mortality in patients who quit vs continued smoking after myocardial infarction. Mortality data were extracted from the selected articles by 2 independent reviewers. Twelve studies were included containing data on 5878 patients. The studies took place in 6 countries between 1949 and 1988. Duration of follow-up ranged from 2 to 10 years. All studies showed a mortality benefit associated with smoking cessation. The combined odds ratio based on a random effects model for death after myocardial infarction in those who quit smoking was 0.54 (95% confidence interval, 0.46-0.62). Relative risk reductions across studies ranged from 15% to 61%. The number needed to quit smoking to save 1 life is 13 assuming a mortality rate of 20% in continuing smokers. The mortality benefit was consistent regardless of sex, duration of follow-up, study site, and time period. Results of several cohort studies suggest that smoking cessation after myocardial infarction is associated with a significant decrease in mortality.
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                Author and article information

                Journal
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                10 October 2011
                2011
                : 10
                : 19
                Affiliations
                [1 ]Service de cardiologie, Hôpital Général de Grand Yoff, Dakar, Sénégal
                [2 ]Clinique cardiologique, Hôpital Aristide Le Dantec, Dakar, Sénégal
                Author notes
                [& ]Corresponding author: Docteur Alassane Mbaye, Faculté de Médecine, Pharmacie et Odontologie, Université Cheikh Anta Diop de Dakar, Service de cardiologie de l'Hôpital Général de Grand Yoff de Dakar, BP 3270 Dakar, Sénégal
                Article
                PAMJ-10-19
                3224056
                22187601
                9d3716f7-dadc-4601-9511-9f0fe51fcdc5
                © Alassane Mbaye et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 February 2011
                : 11 September 2011
                Categories
                Research

                Medicine
                tabagisme,sevrage,coronaropathie,risque cardio-vasculaire,senegal
                Medicine
                tabagisme, sevrage, coronaropathie, risque cardio-vasculaire, senegal

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