CARDIOVASCULAR EFFECTS OF TOBACCO – HOW TO OVERCOME

Tobacco use has predominantly negative effects on human health. Tobaccosmoke contains more than 70 chemicals that cause cancer. Tobacco also containsnicotine, which is a highly addictive psychoactive drug. Cigarettes sold in underdeveloped countries tend to have higher tar content, and are less likely to befiltered, potentially increasing vulnerability to tobacco smoking related disease in these regions.

Tobacco use is the single greatest cause of preventable death globally. As many as half of people who use tobacco die from complications of tobacco use. The WHO estimates that each year tobacco causes about 6 million deaths (about 10% of all deaths) with 600,000 of these occurring in non-smokers due to second hand smoke. In the 20th century tobacco is estimated to have caused 100 million deaths.

There are approximately 120 million smokers in India. According to WHO, India is home to 12% of the world’s smokers. More than 10 million die each year due to tobacco in India. According to a 2002 WHO estimate, 70% of adult males in India smoke. Among adult females, the figure is much lower at between 13–15%. Smokeless tobacco is more prevalent than cigarettes or bidis in India.

Tobacco will be responsible for 1 in 5 of all male deaths and 1 in 20 of all female deaths in the country. This means approximately 1 million Indians would die annually from smoking. According to the Indian Heart Association, India accounts for 83% of the world’s heart disease burden, despite having less than 20% of the world’s population. The IHA has identified reduction in smoking as a significant target of cardiovascular health prevention efforts.

How does smoking change the heart and blood vessels?

Inhalation of tobacco smoke causes several immediate responses within the heart and blood vessels. Within one minute the heart rate begins to rise, increasing by as much as 30 percent during the first 10 minutes of smoking.

Exposure to tobacco smoke is known to increase oxidative stress in the body by various mechanisms, including depletion of plasma antioxidants such as vitamin C.

The usage of tobacco has also been linked to Buerger’s disease (thromboangiitis obliterans) the acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet.

Smoking tends to increase blood cholesterol levels. The ratio of HDL to LDL, tends to be lower in smokers compared to non-smokers. Smoking also raises the levels of fibrinogen and increases platelet production (both involved in blood clotting) which makes the blood thicker and more likely to clot.

Carbon monoxide binds to hemoglobin, resulting in a much stabler complex than hemoglobin bound with oxygen or carbon dioxide—the result is permanent loss of blood cell functionality.

Atherosclerosis, in which arteries narrow and become less flexible, occurs when fat, cholesterol, and other substances in the blood form plaque that builds up in the walls of arteries. The opening inside the arteries narrows as plaque builds up, and blood can no longer flow properly to various parts of the body. Smoking increases the formation of plaque in blood vessels.

Coronary Heart Disease occurs when arteries that carry blood to the heart muscle are narrowed by plaque or blocked by clots. Chemicals in cigarette smoke cause the blood to thicken and form clots inside veins and arteries. Blockage from a clot can lead to a heart attack and sudden death.

Stroke is a loss of brain function caused when blood flow within the brain is interrupted. Strokes can cause permanent brain damage and death. Smoking increases the risk for strokes. Deaths from strokes are more likely among smokers than among former smokers or people who have never smoked.

Peripheral Arterial Disease (PAD) and peripheral vascular disease occur when blood vessels become narrower and the flow of blood to arms, legs, hands and feet is reduced. In extreme cases, an infected limb must be removed. Smoking is the most common preventable cause of PAD.

Abdominal Aortic Aneurysm is a bulge or weakened area that occurs in the portion of  the aorta that is in the abdomen. The aorta is the main artery that carries oxygen-rich blood throughout the body. Smoking is a known cause of early damage to the abdominal aorta, which can lead to an aneurysm. A ruptured abdominal aortic aneurysm is life-threatening; almost all deaths from abdominal aortic aneurysms are caused by smoking. Women smokers have a higher risk of dying from an aortic aneurysm than men who smoke.

While smoking is a direct cause of cardiovascular disease and death, you don’t have to be a smoker to be at risk. Non smokers who are regularly exposed to second hand smoke have a 25 to 30 percent increased risk of coronary heart disease than those not exposed. Second hand smoke exposure also increases your risk of having a heart attack or stroke.

Why quit smoking?

The best way to safeguard your heart from smoking-related disease and death is to ever start using cigarettes, but if you are a smoker, the earlier you are able to quit, the better. Quitting smoking benefits your heart and cardiovascular system now and in the future:

• Twenty minutes after you quit smoking, your heart rate drops.
• Just 12 hours after quitting smoking, the carbon monoxide level in the blood drops to normal, allowing more oxygen to vital organs like your heart.
• Within a year, the risk of heart attack drops dramatically, and even people who have already had a heart attack can cut their risk of having another if they quit smoking.
• Within five years of quitting, smokers lower their risk of stroke to about that of a person who has never smoked.

Tips to help users quit using tobacco products:

• Think about why you want to quit.
• Pick a stress-free time to quit.
• Ask for support and encouragement from family, friends, and co-workers.
• Start doing some exercise or activity each day to relieve stress and improve your health.
• Get plenty of rest.
• Eat a balanced diet.
• Join a smoking cessation program, or other support group.
• Disconnect your activities of smoking and replace them with newer healthier activities.

In some cases, nicotine replacement products can help break a smoking habit. Nicotine replacement products continue to give smokers nicotine to meet their nicotine craving. However, nicotine replacement products do not contain the tars and toxic gases that cigarettes emit. Pregnant or nursing women and people with other medical conditions should consult with their healthcare provider before using any nicotine replacement products. Some examples of nicotine replacement products include:

• Nicotine chewing gum. An over-the-counter chewing gum that releases small amounts of nicotine to help reduce nicotine withdrawal symptoms.•
• Nicotine patch. An over-the-counter patch applied to the upper body once a day that releases a steady dosage of nicotine to help reduce the urge to smoke.
• Nicotine inhaler or nose spray.

Medicines to help you quit smoking

• Bupropion. This is a non-nicotine option to help people stop smoking. It is approved by the FDA. Offered in pill form to smokers who want to quit, bupropion has been shown to alter mood transmitters in the brain that are linked to addiction. Bupropion must be prescribed by a healthcare provider and may not be right for everyone. Ask your healthcare provider for more information.
• Varenicline. This is also a non-nicotine pill to help you quit smoking. It is approved by the FDA. It targets the nicotine receptors in the brain. Varenicline attaches to the receptors and blocks nicotine from reaching them. This decreases the desire for nicotine. Varenicline may not be right for everyone.

Each Quit Attempt is a Step Forward

If you are among the many million adults who smoke cigarettes in this country, and your new resolution is to quit smoking, either for the first time or to make another attempt, do not give up, and know that you are not alone. Many smokers do not quit on their first attempt and need several tries before they succeed. Even small successes are wins. For instance, you may find that the next time you try to quit, you are able to go longer without a cigarette than the last time; or you might discover exercise helps to stave off your cravings. Each time you make a quit attempt, you learn new techniques to implement and move one step closer to being able to call yourself a “former smoker.”