Smoking is one of the strongest modifiable risk factors for coronary artery disease. It is the cause of approximately 10–30% of deaths due to cardiovascular disease around the world. There is a 50% reduction in the risk of myocardial infarction by one year for people who successfully quit smoking. Considering the risk associated with smoking and the benefits of smoking cessation, it is important to identify and implement effective smoking cessation strategies. There are pharmacological as well as non-pharmacological interventions to assist in smoking cessation. Pharmacological therapies including nicotine replacement therapy; bupropion and varenicline have generally been studied more in patients with cardiovascular disease than the non-pharmacological interventions. Non-pharmacological strategies for smoking cessation include behavioural interventions such as counselling sessions and cognitive behavioural therapy. Studies and randomised controlled trials have demonstrated the safety of most of the pharmacological interventions. Nonetheless, the success rates are variable for the different pharmacological options. Data suggest that greater success can be achieved in smoking cessation with a combination of pharmacological and non-pharmacological treatment. However, more studies are needed to explore the best therapeutic options to improve the success of smoking cessation.

Background: ESC recommends ticagrelor over clopidogrel for the treatment of acute coronary syndrome (ACS) but the lack of evidence for elderly patients (≥75) and concerns over bleeding has led to significant variability in its use within the UK. Our aim is, therefore, to compare the safety of ticagrelor compared to clopidogrel in real-world elderly patients admitted with ACS and managed either medically or through percutaneous intervention. Methods: Unselected elderly patients (≥75) admitted to Royal Berkshire Hospital with ACS (2013–2015) were identified and followed for 1 year. The primary outcomes were bleeding events (TIMI criteria), all-cause mortality, cardiovascular mortality, ischemic stroke, angina, NSTEMI and STEMI. Results: A total of 288 patients with ACS were discharged with aspirin and either clopidogrel (137) or ticagrelor (151). In total, 152 of these patients underwent invasive angiography and revascularization. The baseline clinical characteristics and crusade bleeding score were similar between the groups receiving ticagrelor or clopidogrel. There were no significant differences in all-cause mortality (8.8% vs. 10.6%), cardiovascular mortality (2.9% vs. 2.0%), ischemic stroke (0.7% vs. 2.0%), angina (6.6% vs. 5.3%) or STEMI (2.2% vs. 1.3%). Patients on clopidogrel, however, had increased events of NSTEMI compared to ticagrelor (8.0% vs. 2.0%, OR 4.481, 95% CI 1.223–16.42) and overall MI (10.2% vs. 3.3%, p = 0.030). No difference was observed in either major (8.8 vs. 8.6%) or minor TIMI bleeding (18.2% vs. 20.5%) and after propensity score matching (minor bleeding p = 0.39, major bleeding p = 0.76). Conclusions: In this real-world analysis, ticagrelor did not increase major or fatal bleeding compared to clopidogrel in elderly patients. In view of the mortality benefit in the large trials, additional cardiovascular benefit of ticagrelor should not be withheld on the basis of age as a perceived risk factor for bleeding in ACS.