Cardiovascular Institute and Center for Cardiovascular Health

Smoking

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Smoking is one of the major risk factors for developing heart disease (cardiovascular disease). Smoking also interacts with other risk factors. For example, if you smoke and also have high blood pressure, your risk of having coronary artery disease is greater than it would be by just adding the two risks.

Does smoking cause high blood pressure (hypertension)?
If you do not already have high blood pressure, you will not get it from smoking. If you do have high blood pressure, smoking speeds up the development of a dangerous form of it (malignant hypertension), and increases your risk of developing cardiovascular disease.

Will smoking cause atherosclerosis?
Atherosclerosis or "hardening of the arteries" may be caused by and accelerated by cigarette smoking. Atherosclerosis of the coronary arteries occurs when there is a narrowing of the inner walls of the arteries through build up of fatty deposits.

Smoking lowers your levels of high-density lipoprotein cholesterol ("good" cholesterol) and raises your levels of low-density lipoprotein cholesterol ("bad" cholesterol). It decreases the movement of cholesterol through the body, and contributes to its accumulation in your coronary arteries. This puts you at a higher risk for heart attack and stroke.

Does smoking affect my other arteries?
Smoking may cause peripheral vascular disease, which is the narrowing of the arteries that carry blood to the leg and arm muscles. This disease is found more often and more severely in smokers than in nonsmokers. The likelihood of limping, amputation, and failure to successfully treat this disease, is significantly higher among smokers.

Smoking also narrows the arteries in the brain and the arteries in the neck which lead to the brain (carotids). This raises the risk of stroke.

What is coronary thrombosis and how does smoking affect it?
Smoking increases the likelihood of coronary thrombosis or blood clots in the arteries leading away from the heart. Smoking does this by increasing the factors that lead to this disease. For example, smoking causes platelets (clotting agents) to become sticky and aggregate. It also makes the blood thicker and shortens the time it takes to make a blood clot in the coronary arteries..

What is coronary artery spasm and how does smoking affect it?
Coronary artery spasm is a spontaneous narrowing of a coronary artery in the absence of exertion. You experience this narrowing as chest pain (angina). The spontanesous narrowing of the coronary artery, reduces blood flow to the heart muscle, which can lead to a heart attack (myocardial infarction).

If you are a current smoker, you have twenty times the risk of coronary artery spasm than if you are a nonsmoker.

Does smoking affect my blood and heart rate?
The nicotine in cigarettes temporarily increases your heart rate and blood pressure. It also raises the heart's oxygen requirements. To complicate matters, the carbon monoxide in smoke lowers the amount of oxygen available in the circulating blood.. This reduces the oxygen going to various parts of the body - including the heart - just when it's most needed.

The increased heart rate and blood pressure and the decrease in oxygen also increase your chances of developing a serious heart condition known as "arrhythmia" (irregular heart beats).

What happens if I smoke after undergoing heart surgery?
If you smoke after undergoing coronary bypass surgery, you may cause damage to the blood vessel grafts. Smoking may cause the cells in the grafts to proliferate and narrow the grafts This increases your risk of having chest pain (angina pectoris), heart attack and the need for repeat coronary bypass surgery

What is the relationship between smoking and the birth control pill?
If you are taking birth control pills and you smoke, you are thirteen times as likely to develop coronary artery disease than if you do not smoke. You are also increasing your risk of peripheral vascular disease and stroke.

Why is passive smoking bad for me?
Environmental tobacco smoke, second hand smoke, or sidestream smoke, is the smoke emitted into the surrounding air from a burning cigarette between puffs. It is inhaled by both the smoker and the nonsmokers in the room. This inhalation is often referred to as "passive smoking".

Sidestream smoke contains similar harmful components as does mainstream (puffed) smoke . It actually contains greater amounts of some of these compounds, such as carbon monoxide, which adversely affects the delivery of oxygen to the heart.

The amount of exposure is also important. A significant association exists between the number of cigarettes smoked per day by a spouse, and the risk of heart attack for the passive smoker If your spouse smokes twenty or more cigarettes per day, you have a four times greater risk of a heart attack.

Passive smoking is also dangerous outside the home. The risks from passive smoking at work are approximately the same as those from exposure at home.

As in active smoking, passive smoking affects other coronary risk factors such as hypertension, family history of heart attack and diabetes.

What about cigar smoking?
Whether smoking cigars increases your risk for coronary artery disease is up for debate. Cigar smoking may be less likely to cause coronary artery disease because cigar smokers are less likely to inhale. Cigars may cause other problemssuch as raising the risk of certain circulatory heart ailments.

If smoking has already caused so much damage, will quitting really help?
Yes, within one year of quitting, your risk of developing coronary artery disease will drop by 50%. Three or four years after quitting, your risk will approach that of people who have never smoked. Research has shown that you will reap the benefits of quitting, no matter what your age.

I've decided to finally quit smoking. What bodily changes should I expect?
According to the National Cancer Institute, within 12 hours of smoking your last cigarette, the levels of carbon monoxide and nicotine in your system will decline rapidly. Your heart and lungs will begin to heal.

Do not be alarmed if you feel worse before you feel better. You should expect to undergo withdrawal symptoms . Remember these symptoms are just temporary.

When you quit smoking, your metabolism may slow down. This leads to weight gain. You may experience irregularity and dry, sore gums or tongue. Some people feel edgy, hungry, tired, and short-tempered. You may have trouble sleeping and may cough a lot.

Your body will be cleansed of nicotine in 2-3 days, but you may continue to experience withdrawal symptoms for up to 1-2 weeks.

Within a few days your sense of taste and smell may improve. You will breathe more easily.

What advice and recommendations do you have about quitting?
There is no magical approach to quitting that is going to work for everybody. You may find that a combination of the following tactics, will be your best bet for success.

Nicotine replacement therapy: gum and patches
Nicotine is a psychoactive drug that induces euphoria. Cessation of smoking results in the loss of this effect. Nicotine replacement therapy ameliorates some of the withdrawal symptoms associated with loss of euphoria. and reduces your craving for cigarettes. There are two types of replacement therapy: nicotine gum and nicotine patch.

When you chew nicotine gum, you release its nicotine. If you smoked one or more packs a day, you will get a reduction of the discomfort of withdrawal by chewing gum, but it will not eliminate the symptoms completely. You will also get some of the euphoric effect and addiction potential of nicotine but less than that with cigarettes.[deleted line about "swallowed nicotine]

You must chew the gum slowly to get the effect. When you experience a "peppery" taste, you must then place the gum between your check and gum. You may initially develop hiccups, upset stomach or jaw aches. If you chew correctly, most of the side effects will go away.

Nicotine gum replacement therapy usually takes three to six months.

Nicotine patches deliver nicotine to the blood in your veins through your skin. As with the gum, withdrawal symptoms are reduced in intensity , but not eliminated.

You place a new patch somewhere on your body between your neck and the waist, every day. Patches come in different doses and also in full-dose versus tapering-dose programs. It's a good idea to seek your physician's advice to determine which dose is best for you. The full dose program usually lasts six weeks.

Some people get a rash under the patch. These rashes are usually mild and easily treated. It may help to move the patch to another part of your body. Be aware that if you use the patches at night you may experience sleep disturbances, including vivid dreams.

If you smoke during nicotine replacement therapy, you will likely return to your previous smoking habit.

Are there medications for quitting?
A presscription medicaton called "Bupropion" ( trade names "Wellbutrin" or "Zyban"), has been shown to be effective in helping people to quit. Some of the side effects of Bupropion include dry mouth and insomnia. If you have a preexisting seizure disorder, anorexia nervosa, or bulimia, your chances increase for a seizure while on Bupropion..

Higher doses of Bupropion appear to work better than lower doses and may decrease the weight gain that often accompanies smoking cessation.

Do not take amphetamines to try to quit smoking. They may actually increase smoking.

What else can I do to quit?
Here are some approaches suggested by the National Cancer Institute:

  • Set a target date for quitting - quit day.
  • Throw away your cigarettes and matches. Hide your lighters and ashtrays.
  • Have your teeth cleaned by the dentist.
  • Buy flowers Enjoy the scent.
  • Quit smoking during a vacation
  • Involve your friends and family for support
  • Change to a brand you find distasteful
  • Drink milk (some find it incompatible with smoking)
  • Get up from the table after eating and brush your teeth immediately
  • Get plenty of rest
  • Use positive thinking
  • Learn relaxation techniques
  • Keep your hands busy

Will cutting back on the number of cigarettes lower my risks for heart disease?
Cutting back may help you as a way of practicing quitting. It probably will not reduce your risks, because generally smokers who cut back inhale more often and more deeply. In effect, they haven't cut back at all. The same situation occurs when you switch to low-tar or low-nicotine cigarettes.

What if I have a relapse?
Most relapses occur in the first week of quitting. The vast remainder of relapses occur in the first three months. These are usually preceded by a trigger event. If you know and can anticipate your potential trigger events, you may deal with them effectively. Potential triggers include:

Work pressure, eating, drinking an alcoholic beverage or coffee, talking on the phone, being around smokers, playing cards or games, being under time pressure, getting into an argument, and feeling sad or frustrated

If you have a relapse, don't despair. Change is easier said than done. Nowadays, people are more realistic about what it takes to give up and stay off cigarettes. Remember: most ex-smokers tried to quit several times, before they finally succeeded.

What are statistics on smoking?

  • Every year, more than 400,000 people die from smoking related illnesses in the United States alone.
  • Cigarette smoking is one of the major risk factors for heart disease. It is responsible for between 17% and 30% of all deaths from cardiovascular illness.
  • The effects of cigarette smoking are dose-related. Women who smoke more than 25 cigarettes per day are five times more likely to eventually suffer from coronary artery disease than nonsmokers.
  • Any amount of smoking is dangerous. Even if you smoke as few as 1 to 4 cigarettes per day, you significantly increase your risk of coronary artery disease.
  • If you are taking birth control pills and also smoke, you are thirteen times as likely to develop coronary artery disease than if you do not smoke.
  • The American Heart Association estimates that every year from 37,000 to 40,000 people die from heart and blood vessel disease caused by passive smoking.
  • More than three million Americans quit smoking every year.
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