Sochor et al. must be commended for their concerns about the evolution of smoking prevalence in patients with coronary artery disease who underwent their first percutaneous coronary intervention. Their findings deserve comment.

The 12-month quit rate did not change significantly from 1999 to 2010. This is not surprising. First, this reflects the lack of will for effective tobacco control policies: current cigarette smoking in adults in the United States only decreased from 20.9 in 2005 to 17.8 in 2013. Accordingly, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking in adults to 12% by 2010 could be attained only by 2030. Second, similar findings are observed in Europe. EUROASPIRE collates indicators on treatment 1 year after a cardiac event in 22 European countries. From 1995–1996 to 2006–2007, the proportion of patients who smoke has remained nearly the same (20% to 18%), but the proportion of women smokers has increased.

The strongest predictor of smoking cessation at 6 months was participation in cardiac rehabilitation programs (odds ratio 3.17, confidence interval 2.05 to 4.91). Sadly, in Europe, only 36.5% (from 15.9% to 68.1%) of patients having a coronary event or revascularization before the age of 80 years can benefit from cardiac rehabilitation programs.

Why is there not enough concern for cardiac rehabilitation programs in countries which can afford them? They may remain too cheap compared to the spiraling cancer drug prices. For example, nab-paclitaxel (Abraxane) improves median survival for metastatic non–small lung cancer by 0.08 years; on a crude metric, this is $400,000 per year of life gained.

Should the cost of cardiac rehabilitation programs be raised? Nothing can be too expensive against tobacco, the chief preventable cause of illness and death in our societies.