Association between smoking cessation and short-term angina symptoms in patients with vasospastic angina: a post hoc analysis of a randomized controlled trial

Background &Purpose Current clinical guidelines unequivocally advocate for absolute smoking cessation as a cornerstone of vasospastic angina (VSA) management. However, empirical data detailing the short-term symptomatic impact of smoking cessation, particularly when instituted alongside contemporary standard pharmacological therapy, remain scarce. This study aimed to evaluate the weekly trajectories of angina-related symptoms following smoking cessation in patients with VSA. Methods This post hoc analysis utilized data from a prospective randomized controlled trial evaluating VSA treatments. After excluding 7 never-smokers from the initial 40 VSA patients , the remaining 33 current smokers were stratified into two groups based on their follow-up smoking status: 'continued smoking' (n=21) and 'smoking cessation' (n=12). The efficacy and safety regarding angina-related outcomes—specifically pain intensity , chest pain frequency , duration , and additional sublingual nitroglycerin use —were assessed via weekly questionnaires over a 4-week period. Inter-group changes from baseline were analyzed using rank-based analysis of covariance, adjusting for baseline values and randomized treatment allocation. Results Baseline characteristics were well-balanced between the two groups, barring a longer baseline chest pain duration in the cessation cohort. At the 7-day follow-up (Week 1), the smoking cessation group exhibited significantly lower pain intensity scores and a pronounced reduction in supplementary sublingual nitroglycerin use compared to the continued smoking group. Baseline-adjusted analyses confirmed that smoking cessation facilitated rapid early symptom control ; however, these pronounced early symptomatic advantages did not maintain persistent statistical significance across the entirety of the 4-week follow-up period. Conclusions In VSA patients receiving standard pharmacological therapy, smoking cessation is associated with a rapid improvement in angina symptoms and a significantly reduced reliance on sublingual nitroglycerin within the first week. These findings underscore that smoking cessation yields clinically meaningful early symptomatic benefits beyond standard pharmacotherapy, reinforcing its critical role in the acute management phase of VSA.