CIGARETTE SMOKING AND CORONARY HEART DISEASE: Risks and Management
Section snippets
HEALTH RISKS OF CIGARETTE SMOKING
Overwhelming epidemiologic evidence supports the conclusion that smoking is a cause of cardiovascular disease. A strong and consistent dose-response relationship has been demonstrated between CHD and the duration and intensity of smoking in numerous observational epidemiologic studies conducted in many nations. 25, 49, 102, 104, 108 In both men and women, smoking is a major cause of cardiovascular disease, including myocardial infarction, sudden death, stroke, peripheral vascular disease, and
Primary Prevention of Coronary Heart Disease
Epidemiologic data summarized in the 1990 Surgeon General's Report on Smoking 102 demonstrate that smoking cessation has health benefits for individuals of all ages, including those who stop after the age of 65. 25, 56 The overall mortality rate of former smokers declines gradually, approaching that of those who have never smoked over 10 to 15 years of abstinence. The cardiovascular disease risk reduction occurs more rapidly, however, than that for lung cancer or overall mortality. Studies in
PATHOPHYSIOLOGY
A cigarette is an extraordinarily effective system for the delivery of the multiple constituents of tobacco combustion. Tobacco smoke is composed of over 4000 individual components, of which nicotine and carbon monoxide are the most well studied and, particularly for the cardiovascular system, probably the most important. Atherosclerosis is the consequence of a complex pathogenic process; its clinical expression results from multiple events occurring at the vascular wall. It has long been clear
POPULATION AT RISK
Among adults Americans, the prevalence of cigarette smoking has declined markedly since its peak in 1965, when 40% smoked 102, 104; in 1992, 25.6% of adults smoked. 16 This decline likely reflects growing public awareness of the health hazards of tobacco use. The decline is attributable more to an increase in smoking cessation than to a fall in the rate of smoking initiation, which has not decreased since 1980. Smoking generally begins during childhood and adolescence. Nearly 90% of smokers
SMOKING CESSATION
In the United States, half of those who ever smoked have now quit. 102 Surveys of former smokers reveal that 90% stopped smoking on their own but did not succeed on their first try. 32 Although many smokers regard quitting as an effort requiring only willpower, behavioral scientists liken smoking cessation to a learning process. According to this view, smokers learn from prior mistakes, increasing their likelihood of quitting with subsequent attempts. Most smokers report quitting abruptly
Nicotine Dependency
Tobacco products are addictive. 7 The 1988 Surgeon General's Report on Smoking 102a summarized the evidence and identified nicotine as the addictive drug in tobacco capable of creating tolerance, physical dependence, and withdrawal symptoms in regular users. Nicotine withdrawal symptoms include craving for a cigarette; irritability, anxiety, impatience, and anger; difficulty concentrating; increases in appetite; and sleep disturbances. The symptoms begin within a few hours of the last
SMOKING CESSATION TREATMENT
A variety of techniques have been developed to promote smoking cessation. 92, 102 Both behavior-modification programs and nicotine-replacement therapy are relatively effective, and combining the two in appropriate patients is the most effective smoking cessation method. Although hypnosis has been advocated, it is no better than behavioral methods. 102 Acupuncture appears to be ineffective. 58, 92
MANAGEMENT OF THE SMOKER WITH (OR AT RISK OF) CORONARY HEART DISEASE
Although the majority of smokers are aware that their behavior is harmful to health, 104 developing the symptoms of a smoking-related disease makes that knowledge personally salient and appears to increase resolve to quit. The threat or diagnosis of cardiovascular disease is a particularly powerful event in spurring behavior change (Table 2). For example, the development of CHD and recent hospitalization were two of the strongest predictors of smoking cessation among individuals in the
MANAGEMENT OF THE HOSPITALIZED SMOKER
Recently regulations adopted by the Joint Commission on the Accreditation of Health Care Organications (JCAHO) require US hospitals to be smoke free. 79 Consequently, hospitalized smokers must abstain temporarily from tobacco use, and hospitalization presents all smokers with an opportunity to stop smoking. The data cited previously indicate that smokers hospitalized with CHD, regardless of whether the reason is myocardial infarction, unstable angina, coronary angiography, percutaneous
MANAGEMENT OF THE SMOKER IN OUTPATIENT PRACTICE
Physician advice and counseling of smokers seen in office practice is effective in promoting smoking cessation. Routine advice to stop smoking delivered to all patients seen in a general practice was more effective than no intervention in a randomized controlled trial, but overall cessation rates were low, only 5%. 91 To improve on the results of physician advice alone, brief structured smoking-counseling programs for outpatient medical practice have been developed. Most have proved to be more
SUMMARY
Tobacco smoking is the leading preventable cause of death in the United States and an important cause of CHD. The effect of smoking on the cardiovascular system and coronary risk factors is pervasive. Unfavorable effects include acute increases in blood pressure and coronary vascular resistance, reduction in oxygen delivery, enhancement of platelet aggregation, increased fibrinogen, and depression of HDL cholesterol. Smoking cessation reduces cardiovascular morbidity and mortality rates
References (114)
- et al.
Rapid resumption of cigarette smoking following myocardial infarction: Inverse relation to MI severity
Addict Behav
(1982) - et al.
Nicotine effects on eicosanoid formation and hemostatic function: Comparison of transdermal nicotine and cigarette smoking
J Am Coll Cardiol
(1993) The acute influence of smoking on the endothelium
Atherosclerosis
(1992)- et al.
Stopping smoking after myocardial infarction
Lancet
(1974) - et al.
Effects of smoking on survival and morbidity in patients randomized to medical or surgical therapy in the coronary artery surgery study (CASS): 10-year follow-up
J Am Coll Cardiol
(1992) - et al.
Direct effects of smoking on the heart: Silent ischemic disturbances of coronary flow
Am J Cardiol
(1986) - et al.
Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin: The Northern Sweden MONICA study
Atherosclerosis
(1995) - et al.
Smoking status as the new vital sign: Effect on assessment and intervention in patients who smoke
Mayo Clin Proc
(1995) - et al.
Increased frequency of restenosis in patients continuing to smoke cigarettes after percutaneous transluminal coronary angioplasty
Am J Cardiol
(1988) - et al.
Cigarette smoking renders LDL susceptible to peroxidative modification and enhanced metabolism by macrophages
Atherosclerosis
(1989)
A comprehensive model for the treatment of nicotine dependence in a medical setting
Med Clin North Am
Some lessons in cardiovascular epidemiology from Framingham
Am J Cardiol
Short- and long-term effects of smoking on arterial wall properties in habitual smokers
J Am Coll Cardiol
Cost-effectiveness of a smoking cessation program after myocardial infarction
J Am Coll Cardiol
The clinician's role in promoting smoking cessation among clinic patients
Med Clin North Amer
The health consequences of smoking
Med Clin North Am
The cardiovascular pathology of smoking
Am Heart J
Cigarette smoking inhibits basal but not stimulated release of nitric oxide from the forearm vasculature
J Am Coll Cardiol
Some acute cardiopulmonary effects of mainstream and side-stream cigarette smoke in man
Prev Med
Maintaining smoking abstinence after myocardial infarction
J Subst Abuse
Acute effect of cigarette smoking on the coronary circulation: Constriction of epicardial and resistance vessels
J Am Coll Cardiol
Smoking and coronary artery disease
Chest
The influence of cigarette smoking on prognosis after a first myocardial infarction: A report from the Framingham Study
Journal of Chronic Diseases
Effects of smoking cessation on weight gain, metabolic rate, caloric consumption, and blood lipids
Am J Clin Nutr
Cessation of smoking after myocardial infarction: Effects on mortality after 10 years
Br Heart J
Effect of low-level carbon monoxide exposure on onset and duration of angina pectoris
Ann Intern Med
Effect of passive smoking on angina pectoris
N Engl J Med
Effect of smoking on the activity of ischemic heart disease
JAMA
The human cost of tobacco use
N Engl J Med
Pharmacologic aspects of cigarette smoking and nicotine addiction
N Engl J Med
Smoking cessation counseling during periodic health examinations
Arch Intern Med
Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults
Circulation
Cigarette smoking among adults, United States, 1992, and changes in the definition of current cigarette smoking
MMWR Morb Mortal Wkly Rep
Cigarette-attributable mortality and years of potential life lost—United States, 1990
MMWR Morb Mortal Wkly Rep
Medical-care expenditures attributable to cigarette smoking—United States, 1993
MMWR Morb Mortal Wkly Rep
Encouraging primary care physicians to help smokers quit: A randomized controlled trial
Ann Intern Med
Cigarette smoking and serum lipid and lipoprotein concentrations: An analysis of published data
BMJ
Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic event
N Engl J Med
The cost-effectiveness of counseling smokers to quit
JAMA
Training physicians in counseling about smoking cessation: A randomized trial of the "Quit for Life" program
Ann Intern Med
Long term effect on mortality of stopping smoking after unstable angina and myocardial infarction
BMJ
Cigarette smoking and the treatment of angina with propranolol, atenolol, and nifedipine
N Engl J Med
Mortality in relation to smoking: 40 years' observations on male British doctors
BMJ
Respiratory health effects of passive smoking: Lung cancer and other disorders
Effrectiveness of nicotine patch and nicotine gum as individual versus combined treatments for tobacco withdrawal symptoms
Psychopharmacology
Tobacco dependence and the nicotine patch: Guidelines for effective use
JAMA
The effectiveness of the nicotine patch for smoking cessation: A meta-analysis
JAMA
Methods used to quit smoking in the United States: Do cessation programs help?
JAMA
Randomized, controlled trial of clonidine for smoking cessation in a primary care setting
JAMA
Predictors of smoking cessation: The Framingham study
Am J Epidemiol
Cited by (86)
Modifiable and Non-Modifiable Risk Factors for Premature Coronary Heart Disease (PCHD): Systematic Review and Meta-Analysis
2024, Heart Lung and CirculationEffect of Smoking on Outcomes of Allogeneic Transplantation: A Single-Center Analysis
2020, Biology of Blood and Marrow TransplantationCitation Excerpt :In allo-HCT recipients, the conditioning toxicity and allo-immune response may further increase the infiltration of lymphocytes or macrophages [26-29], which eventually might result in the development of BO or IP, although the true reasons remain to be elucidated. Smoking is also associated with coronary disease and stroke [30-33]. However, the present study did not show a significant increase in these complications, since the incidence was very low even in the whole cohort.
Risk factors and indications for readmission after lower extremity amputation in the american college of surgeons national surgical quality improvement program
2014, Journal of Vascular SurgeryCitation Excerpt :A recent meta-analysis on the benefit of preoperative smoking cessation found a 40% decrease in postoperative complications in patients who discontinued tobacco use preoperatively.18 Routine use of proactive smoking cessation strategies, such as in-clinic enrollment in smoking cessation programs during preoperative consultation, may improve our patients' success in this regard.19,20 Intraoperatively, the use of locoregional anesthesia, when possible, avoids the physiologic stress of general anesthesia and may play a role in preventing certain systemic postoperative complications.
Smoking paradox in acute coronary syndrome without st-segment elevation
2011, Medicina ClinicaPsychological distress is independently associated with physical inactivity in Israeli adults
2010, Preventive MedicineCitation Excerpt :Previous studies have also documented minor gender differences in physical activity correlates (Plotnikoff et al., 2004; De Bourdeaudhuij & Sallis, 2002). Smoking and obesity are established risk factors for morbidity and mortality (Rigotti & Pasternak, 1996; Poirier et al., 2006). In our study, these two variables were significantly associated with physical inactivity.
Role of food supplements in CHD
2023, Food Supplements and Dietary Fiber in Health and Disease
Address reprint requests to Nancy A. Rigotti, MD, Tobacco Research and Treatment Center, General Internal Medicine Unit, S-50-9, Massachusetts General Hospital, Boston, MA 02114