Tobacco Use & Heart Health
Tobacco use is the number one preventable cause of morbidity and mortality in the US. One in every six deaths is related to smoking. Smoking also tends to kill people in middle age, leading to decades of life lost. Half of long-term smokers will die of a tobacco-related disease.
The leading cause of death among smokers is not lung cancer – it is heart disease. Of the 404,000 deaths annually attributed to active smoking, 142,600 are due to heart and vascular disease and of the 53,000 nonsmoker deaths due to secondhand smoke about 40,000 are due to heart disease. Exposure to secondhand smoke (the smoke from the end of a lit cigarette and the smoke exhaled by smokers) has immediate adverse effects on the cardiovascular system and causes coronary heart disease.
More than half of the heart attacks in women under 50 are related to smoking. In contrast to cancer, where the risks develop and resolve slowly over time when people start and stop smoking, much of the heart disease risk that smoking imposes is due to the acute toxicity (within minutes) on platelets and endothelial function.
While smoking cessation is beneficial at all ages, the sooner one quits the greater the benefits. A smoker who quits by age 30 returns to the mortality patterns of a nonsmoker. Smoking cessation yields rapid benefits in terms of heart disease; cardiac function starts to improve within a day, and half the excess risk of myocardial infarction is gone in 1 year.
Building Your Motivation to Quit Smoking
While 70% of smokers report wanting to quit smoking, only about 20% report intention to quit in the next 30 days. If you are not yet ready to quit, you can still take steps to move forward in the process. For example:
• Read information on the health benefits of quitting smoking. Make a list of the benefits that are important to you;
• Identify the risks of tobacco use that most concern you;
• Track the number of cigarettes you smoke each day to become more aware of your use of tobacco and to identify ways to limit your smoking;
• Talk with your doctor to learn more about available quit smoking treatments;
• Talk with friends who have quit smoking and ask them how they did it;
• Make your home and car smoke-free zones — this will increase your awareness of your tobacco use, protect your friends and family from secondhand smoke, and support your efforts with quitting.
Tobacco Cessation Treatment
It is now widely accepted that nicotine is as addictive as heroin and causes release of the “pleasure chemical” dopamine and other neurotransmitters in the brain within minutes of the first puff. Nicotine Withdrawal Syndrome is a well-studied disorder and is characterized by anxiety, irritability, restlessness, cravings and negative mood. Put another way, smokers that are quitting and experience this syndrome have developed an acute medical disorder and should receive medications (nicotine replacement therapy, bupropion, or varenicline) to ease this discomfort just as any other patient with temporary acute symptoms would.
A “cold turkey” attempt at quitting is only likely to be 2 to 5% successful at 1 year–medications increase this success rate 5 to 7 fold or more. Why struggle without medications that are proven to be of benefit?
Through behavioral counseling and appropriate use of medications, patients can enhance their chances for quitting. Compared to two decades ago, tobacco users now are able to select from many treatment options for quitting. An analysis of over 8,700 published articles revealed two clear treatment-related themes: 1) the use of approved medications for cessation increases the likelihood of quitting, and 2) the effects of medications for cessation are substantially increased when coupled with behavioral interventions. Behavioral interventions include counseling from a physician or other health care provider, a stop-smoking group, and telephone quitlines. Quitlines are toll-free numbers with counseling available 24-hours a day.
The national quitline phone # is 1-800-QUIT NOW.
Excellent websites with quit smoking resources include:
http://1800quitnow.cancer.gov/ and www.smokefree.gov
The information above is from the UCSF Rx for Change Tobacco Cessation Medical Curriculum Materials: www.rxforchange.ucsf.edu.
