OPINIONS

Cigarette Smoking and Cardiovascular Diseases

Saturday, May 30, 2015

by Dr Harinder Singh Bedi

Smoking kills — Tobacco use is the single most preventable cause of death globally and is currently responsible for killing one in 10 adults. The global tobacco epidemic kills nearly 6 million people worldwide each year, of which more than 600,000 are non-smokers dying from breathing second-hand smoke. Unless we act, the epidemic will kill more than 8 million people every year by 2030. More than 80% of these preventable deaths will be among people living in low- and middle-income countries. Every cigarette takes away five minutes of one’s life.

Dr Harinder Singh Bedi

Dr Harinder Singh Bedi

According to the Indian Council of Medical Research (ICMR), the World Health Organisation (WHO) and the Tobacco Institute of India, there is one death every eight seconds in India directly related to smoking. In India, there are 250 million tobacco users i.e. about 1 in 4. They constitute about 57% of adult males and 3% of adult females. 17% male and 9% female smokers are in the age group of 13-17 years. 50% smoke bidis while 36% chew tobacco/gutka and most of them start smoking at the age of 15 years. Tobacco companies are dumping their stock in India, Indonesia and China – which, according to a World Bank study, are the only countries which have had an increased consumption of tobacco. What is equally alarming is that the companies are targeting the young population to make them addicted – tobacco is as addictive as heroin! About 5,500 Indian children start smoking every day joining the 4 million under 15 children who already use tobacco.

Effect on heart and cardiovascular diseases: Coronary artery disease

Tobacco abuse is a major risk factor for coronary artery disease — blockage of heart arteries leading to a heart attack. According to a WHO estimate, in developing countries, 35% of all deaths related to heart and blood vessel disorders in the 35-69 years age group are related to smoking. The incidence of heart disease is 3-5 times higher in smokers than non-smokers. People who smoke 20 or more cigarettes a day are twice as likely to have a heart attack as non-smokers. Their chances of dying of a heart attack are 70% more than in non-smokers.

How does smoking affect the heart?

Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major independent risk factors for coronary heart disease that you can modify or control. Cigarette smoking is so widespread and significant as a risk factor that the Surgeon General of USA has called it “the leading preventable cause of disease and deaths in the United States.” Cigarette smoking increases the risk of coronary heart disease by increasing blood pressure, decreasing exercise tolerance, promoting the deposition of fat in the wall of the arteries by damaging the cells lining the arteries and increasing the tendency for blood to clot. The effect is cumulative – the more you smoke the greater your risk. A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. People who smoke a pack a day have more than twice the risk of heart attack than non-smokers.

Cigarette smoking is the most important risk factor for young men and women. It produces a greater relative risk in persons under age 50 than in those over 50. Cigarette smoking is an important risk factor for stroke of the brain. It is equally important in causing blockage of the leg arteries leading to gangrene and amputation.

Stroke (cerebrovascular accident): One out of five stroke cases are attributed to smoking. The risk for brain haemorrhage is 3-4 times higher in heavy smokers, while stroke due to occlusion of a brain artery is 1.5-3 times more common in heavy smokers.

Peripheral arterial disease: Hardening of the arteries of the legs is one of the most dreaded complications of smoking. Smokers have a 16 times greater risk of developing peripheral vascular disease (blocked blood vessels in the legs or feet) than people who have never smoked. Over 95 per cent of the patients who have occlusions in the leg arteries are smokers. The blockage, if unchecked, leads to gangrene and amputation of limbs.

Non-cardiovascular health effects:

Respiratory diseases: Smoking is a major cause of respiratory ailments such as lung cancer, chronic bronchitis, frequent pneumonia and respiratory failure. About 80 per cent of the deaths from respiratory diseases are attributable to smoking. Lung cancer accounts for 15% of all cancers in India.

Cancer: Smoking also increases the risk of cancer of the larynx (voice box), mouth cavity, and oesophagus (food pipe).

What about passive or secondhand smoke?

The link between secondhand smoke (also called environmental tobacco smoke) and disease is very strong, and is a major cause of cardiovascular-related disability and death in non-smokers.

Some teens, especially girls, start smoking because they think it may help keep their weight down. The illnesses that smoking can cause, like lung diseases or cancer, do cause weight loss but that’s not a very good way for people to fit into their clothes!

Smoking is Expensive

Not only does smoking damage health, it costs an arm and a leg (actually literally – as it can lead to amputation!). One of the goals of the WHO has been to encourage governments to raise taxes on tobacco to reduce its consumption.

What’s in a Cigarette?How can quitting smoking be helpful?

Quitting smoking helps to prolong a healthy life, reduces risk of diseases (including heart disease, heart attack, high blood pressure, lung cancer, throat cancer, emphysema, ulcers, gum disease and other conditions), improves health and looks (quitting can help you prevent face wrinkles, get rid of stained teeth and improve your skin), improves the sense of taste and smell, and saves money. The main campaign of the WHO in this year’s World No Tobacco Day (31st May 2015) is targeted at the illicit tobacco trade.

All forms of tobacco — cigarettes, pipes, cigars, and smokeless tobacco — are hazardous. It doesn’t help to substitute products that seem like they’re better for you than regular cigarettes — such as filter or low-tar cigarettes. Nicotine in tobacco is responsible for the addictive nature of tobacco. It stimulates the nervous system and the heart. It causes the ‘lift’ experienced seconds after a puff. Stimulation of the nervous system may produce a temporary state of alertness but chronic use leads to a state of over-excitation, lack of sleep, irritability, tremors and nervous exhaustion. Nicotine increases the heart rate by 15-20 beats per minute, can cause palpitation, and increases the blood pressure by 10-20 mm Hg within 3-5 seconds of a puff. Smoking is a slow but sure killer. Indian cigarettes and bidis have a very high nicotine content. Except for the fact that it is addictive, makes you sick and hastens your death, nicotine is a wonderful drug!

Tobacco smoke also contains the deadly carbon monoxide and numerous other solid and gaseous chemicals. Tar is an aggregate of the particulate matter in cigarette smoke. Many chemicals in tar irritate the airway passage of the respiratory tract and stimulate production of sticky mucus causing smokers cough and chronic bronchitis. Other chemicals in tar initiate and perpetuate various types of cancer.

Young people are being targeted by the tobacco companies. Smoking is one of the most important risk factors for heart disease in people below 40 years of age. Three out of four young victims of heart attacks are smokers. Though men are more adversely affected by smoking, the risk of heart disease increases 10 fold in women taking birth control (oral contraceptive) pills. The risk is further accentuated when the smoker has other major risk factors like high blood pressure, high blood cholesterol, diabetes mellitus or a family history of heart disease. I am seeing more and more young patients needing bypass surgery at the age of 30 years and also young patients with lung cancer needing major surgery. The fast paced, adrenaline pumping, deadline and target oriented, sedentary and fast food laced lifestyle is taking its toll. One factor which can be easily controlled is the avoidance of tobacco. Even after a bypass surgery or angioplasty the risk of restenosis is dramatically increased in smokers. In fact some surgeons including my previous chief — Dr (Prof) Mark X Shanahan, chairman of cardiac surgery and heart transplant at St Vincent’s Hospital in Australia — would defer surgery on elective cases who initially refused to commit to a stoppage of smoking after surgery.

Smoke-free workplace may prevent heart attacks

The present nationwide ban on smoking in the workplace is truly commendable and will potentially prevent thousands of heart attacks and strokes. Such a ban also substantially benefits non-smokers who face risks from secondhand smoke.

The good news is that quitting smoking boosts heart health

Smokers who quit or even just cut down on cigarettes can begin to reap the health benefits within a few months. Individuals who gradually quit smoking get improvements in risk factors for heart disease, including lower cholesterol and carbon monoxide levels. It is never too late to stop smoking. The benefits begin as soon as you stop.

Staying smoke free will give you a whole lot more of everything — more energy, better performance, better looks, more money in your pocket, and, in the long run, more life to live!

TABLES:

The mechanisms of tobacco induced cardiovascular diseases are manifold. They are as under:

Mechanisms of Tobacco Induced Cardio-Vascular Disorders

Effects of Tobacco Abuse Consequences
Constriction of blood vessels Increase in blood pressure
Release of stress hormones -increase in heart rate-increase in blood pressure-increase in oxygen requirement

-heart rhythm disorder

Increase in levels of fibrinogen Increased tendency for clotting of blood
Increase in stickiness of blood platelets Increased tendency for clotting of blood
Carbon monoxide toxicity -decrease in heart muscle contraction-heart rhythm disorder
Decrease in oxygen carrying capacity of red blood cells -Hypoxia of body organs-Angina (cardiac muscle pain)
Interference with tissue utilization of oxygen Hypoxia and angina
Damage to inner lining of blood vessels -clotting of blood-increase in blood vessel permeability to fat cells leading to blockages
Decrease in good cholesterol (HDL) levels Increased risk of atherosclerosis

 

Top 10 preventable causes of death according to WHO :

 
  1. Heart disease: Smoking is one of the prime causes
  2. Cancer: Smoking is one of the prime causes
  3. Stroke: Smoking is one of the prime causes
  4. Chronic obstructive lung disease: Smoking is one of the prime causes
  5. Sexually transmitted diseases:
  6. Accidents:
  7. Diabetes:
  8. Suicide:
  9. Kidney disease: Smoking is one of the possible causes
  10. Liver disease: Smoking is one of the possible causes

 

Causes of premature deaths attributed to smoking:

            Heart Disease                                                                      31%
            Stroke + vascular diseases                                               21%
            Lung cancer                                                                        19%
            Chronic Bronchitis + respiratory failure                      10%

 

The writer, Dr Harinder Singh Bedi, is head of the department of cardiovascular and thoracic surgery at the Christian Medical College and Hospital, Ludhiana and was earlier at the St Vincent’s Hospital, Sydney. He is founder president of the North Zone Association of Cardio Thoracic and Vascular Surgeons.

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4 Comments »

Comment by Prof. Manoj Sharma
2015-05-31 15:57:21

years after years some kind of debate comes , some kind of achievements by policy makers are shown, Nationally and internationally and so called great strides made in implementation of tobacco laws,
without knowing as to what exactly is the tobacco related cancer deaths in Indian population because cancer is not declared as a notifiable disease. One does not know how gigantic is the problem .

There is no method to control the usage of tobacco as long as it exists.
There are more fear expressed that if total tobacco ban is implemented there will be other problems as if deaths in millions since independence is no concern.

There are more crocodile tears shed for the people employed in tobacco business as if farmers other than tobacco growers do not commit suicide . For 4 million tobacco workers there are worries while there are every possible way to find alternative jobs and profession….what about DPs after constructions of dams like Narmada and Tehri?

But then there is no concern and worry about 4 million plus deaths that happen in every decade in this country due to tobacco related diseases.

when it comes to tobacco taxation the policy makers seem to be very happy with 1-2 percent increase that too on Cigarettes, Biri and chew able tobacco versions are totally forgotten even though they are doing more damage.

Never in the History of India the MPs have come forward to justify existence of tobacco telling anecdotes as to how tobacco users in his family circles lived longer.

Year after years pass more and more tobacco users are added in this country , they do add to financial burden on health care but at the same time they sacrifice their lives to reduce the population of this country in some way as non of the Govts are able to do this great job .
May be is this the reason as to why there is no total ban on tobacco.?

We are answer less on media channels when we tell the statistics of mortality and morbidity due to tobacco and then the caller asks, ” if tobacco is so band why is not Govt banning it for ever ….Na rahega Baans na bajegi Bansuri”

 
Comment by shridhar Dwivedi
2015-05-31 21:20:18

What Prof. Bedi has written is very true. left on to me I will summarize in following lines :
1. तम्बाकू मौखिक हो या धूम्रपान ,
मचाती शरीर में विध्वंश घमासान  I 

2.Mouth as if a tobacco bowl,
Lungs filled with fume tar coal,
Tummy hot lots of fat oxidants,
Body laden with fat all over ||
Day or night it is all ethanol,
Stomach turned in chemist’s shop,
Born with clean heart and soul,
Body turned into trash ash coal II

 

 
Comment by Harinder Singh Bedi
2015-06-01 09:07:04

Very well and pithily summarised Prof Dwivedi !

 
Comment by shridhar Dwivedi
2015-06-06 05:54:11

तम्बाकू तुम्हारी परछाई भी बुरी ,
तुमसे जिसने मिलाया हाथ ,
उसका संसार से हुआ पत्ता साफ I

 
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