In a dissertation was established that only five of the studied indicators, namely - the level of nicotine dependence (SI), the level of anxiety according to the HADS scale, BMI, the presence of concomitant diseases and family status are independent predictors of smoking cessation. It was determined that the chances of quitting smoking are 79% (95% CI 1.25 to 2.56) higher in cardiac rehabilitation patients with high BMI and 3 times (95% CI 1.01 to 8.40) - in patients who are in family status. High comorbidity, higher levels of SI, and anxiety were significantly associated with a reduced likelihood of quitting smoking.
The existence of a multiple strong correlation between the levels of LDL-C, C-reactive protein (CRP) and tobacco dependence according to TF (R=0.88, with p=0.024 (according to Fisher)) was proved, which allowed to establish a significant high predicted risk of detection of DLP with a proatherogenic focus (↑LDL-C) and high activity processes of systemic inflammation (↑ CRP) in patients with a high level of nicotine addiction.
The impact of persistent smoking on the risks of not reaching the target levels of important prognostic indicators of the lipid profile after an acute coronary event was studied. It turned out that persistent smoking during the CR program significantly increases the risk of not reaching the target value of CHL < 4,5 mmol/l - by 55% (OR=1.55, CI=1.15-2.26), triglycerides (TG) <1.7 mmol /l - by 23% (OR=1.23, CI=1.05-1.43), LDL-C <1.4 mmol/l - by 3.2 times (OR=3.24, CI=1, 14-9.54), HDL-C > 1.3 w, (> 1,0 m) mmol/l and non-HDL-C < 2,6 mmol/l - 2.5 times (OR=2.48, CI=1.24-4.99) (OR =2.51, SI=1.18-4.74). At the same time, in the subgroup of successful complete smoking cessation (IA), we observed significantly lower risks of not reaching the target levels of the listed indicators at the end of the CR program.
It was established that quitting smoking significantly improves the daily blood pressure profile in the dynamics of sanatorium treatment. In subgroup IA patients, the most expressive positive dynamics of such indicators as average daily HR, BP Var, and levels of morning BP rise were found. It is worth noting that in persistent smokers (IB) there was no significant reduction and achievement of target values of similar DMBP indicators against the background of appropriate physical training.
Our study proved that the risks of not reaching the target levels of prognostically important indicators of blood pressure regulation are significantly increased in patients who continued to smoke (IB) during the CR program. It was established that persistent smoking significantly increases the risks of insufficient nocturnal reduction of SBP and DBP (<10%, non-dippers) - 2.6 times (OR = 2.57, CI = 1.28-5.16) and 2.1 times (OR = 2.07, CI = 1.09-3.92), the risks of registering morning rise speed (MRS) SBP > 55 mm. Hg and DBP > 35 mm. Hg - almost 5 times (OR = 4.87, CI = 2.14-11.05) and 3.4 times (OR = 3.39, CI = 1.74-6.60), which significantly exceeds such risks compared with subgroup IA and group II.
In the course of the study, it was established that quitting smoking in combination with regular physical activity (PhA) during the СR program significantly accelerates the processes of normalization of intracardiac hemodynamic indicators. In particular, the analysis of 24-day dynamics (Δ) revealed a significant decrease in the Tei index (IndTe) by 14.1%, the sphericity index (IndSp) by -4.6%, the asynergy index (IndA) by -5.5% and a significant increase in the proportion of normal myocardium by 8.1%. In subgroup IB, the intensity of the dynamics of these indicators was the lowest and without reliable significance. At the same time, the impact of persistent smoking and individual drugs on the risk of not reaching the target levels of the IndTe was studied.
It has been proven that persistent smoking increases the risk of low distance ability (1.5 km and less) by 8 times (OR=8.16, CI=1.27-12.48). At the same time, successful smoking cessation (IA) significantly increases the chances of achieving a high distance ability (3 km and more) by 55% (OR=1.55, CI=1.02-2.52).
The method of multivariate regression analysis established the inverse strong influence of these indicators on the values of the 6-minute walking test was proved: R=0.92, with p<0.001 (according to Fisher).
