Smoking Cessation

Smoking cessation has immediate positive consequences not only in younger, but also in elderly patients. Smoking cessation after aortocoronary bypass surgery in patients over 65 years of age decreases the mortality within a year after surgery by approximately 40%.24 Smoking leads to an immediate increase in blood pressure, peripheral vascular resistance and heart rate and leads to a decrease in flow-mediated vasodilatation of the arteries with concomitant increase in clotting tendency and a decrease in HDL cholesterol.25 This indicates that elderly smokers should be encouraged to stop smoking as is done in younger patients and they should also be offered nicotine replacement medications for suppression of craving if necessary. This recommendation is appropriate up to the age of 75-80 years; in old-old patients smoking cessation counseling becomes somewhat questionable, especially if patients are socially isolated after the loss of their friends and if they have the feeling that smoking is part of their quality of life.

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