Smoking a serious health hazard

Smoking is clearly one of the most important and preventable causes of heart disease. Contrary to the prevalent belief that smoking only leads to chronic bronchitis and in some instances lung cancer, it is actually the most important, cause of premature heart attacks.

In a study conducted by the author over 25 years ago in Delhi, and published in the American Heart Journal (1986), it was present as a risk factor in 76% of patients below the age of 40 years who had suffered a heart attack. Currently, there are approximately 5.5 crore patients with ischemic heart disease in India.

Smoking leads to fat depositions and heart attacks:

Smoking is a major cause of atherosclerosis— a build-up of fatty substances in the arteries. Atherosclerosis occurs when the normal arterial lining deteriorates, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries.

In coronary artery disease, the arteries that supply blood to the heart become severely narrowed, decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.

In peripheral artery disease, atherosclerosis affects the arteries that carry blood to the arms and legs. As a result, the patient may experience painful cramping of the leg muscles when walking (a condition called intermittent claudication). Peripheral artery disease also increases the risk of stroke.

What’s the link between smoking and heart attack?

A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no ‘safe’ smoking level. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than nonsmokers.

In a study to assess the risk factors in patients with heart attacks (INTERHEART study) done in 48 countries with a significant contribution from south Asia it was observed that smoking 1 to 9 cigarettes per day increases the risk of heart attack by 1.5 times, smoking 10 to 19 cigarettes per day increases risk by 2.8 times, and smoking more than 20 cigarettes per day increases risk by 4.7 times.

The risk increases several folds in women who smoke and also use oral contraceptives.

No Form of smoking is safe

All forms of smoking are equally bad; in fact, smoother and more refined forms may be more dangerous, since there is a tendency for deeper inhalations and the toxins reach the blood in higher concentrations, leading to more damage.

Every form of tobacco smoke has multiple poisons, including addictive nicotine, carbon monoxide, tars and hydrogen cyanide. In addition, there are 4,000 other chemicals of varying toxicity, including 43 known carcinogens.

What is second-hand (passive) smoking?

Cigarette smoke does not just affect smokers. When you smoke, the people around you are also at risk for developing health problems, especially children. Environmental tobacco smoke (also called passive smoke or second-hand smoke) affects people who are frequently around smokers. Second-hand smoke can cause chronic respiratory conditions, cancer and heart disease.

People exposed to second-hand smoke have in excess of 90% risk of having a heart attack. For this reason, smoking is banned in public places and situations where large numbers of individuals assemble and breathe the same air.

Scientific facts of how smoking leads to lethal heart disease:

• Decreased oxygen to the heart and to other tissues in the body
• Decreased exercise tolerance
• Decreased HDL (good) and increased LDL (bad) cholesterol.
• Increased blood pressure and heart rate
• Damage to cells that line coronary arteries and other blood vessels
• Increased risk of developing peripheral artery disease and stroke
• Increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis and emphysema
• Increased risk of developing diabetes
• Increase tendency for blood clotting
• Increased risk of spasm of the arteries.

Tips to quit smoking

There's no one way to quit that works for everyone. To quit smoking, you must be ready, emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. So plan ahead.

Once you have quit, stick to the following suggestions:

• Get rid of all cigarettes.
• Put away all smoking-related objects, such as ashtrays.
• If you live with a smoker, ask that person not to smoke in your presence. Better yet, convince them to quit with you.
• Don’t focus on your cravings. Remember that what you’re feeling is temporary and remind yourself why you want to quit.
• Keep yourself busy! Review your list of activities you can do instead of smoking.
• When you get the urge to smoke, take a deep breath. Hold it for ten seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
• Keep your hands busy. Play with a pencil or straw, or work on a computer.
• Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
• When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
• Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
• Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.
• Remind yourself you are a non-smoker. Non-smokers don't smoke.
• Exercise. Exercising has many benefits and will help you relax.

A number of commercial drugs have been developed to help people quit smoking. One of these agents is Varneciline (Champix). It helps in reducing the pleasurable effects of smoking and reducing the craving. These drugs are expensive, approximately Rs. 10,000 per person for a course, and the success rate is about 30- 40%. But let’s face it, nothing works better than strong will power, good counseling and a genuine desire to quit. Bupropion ios another agent.

It’s never too late to quit smoking. Remember that quitting reduces your risk to that of a non-smoker within 3 years.

Interestingly, the quit rate is very high after an individual suffers a heart attack or a stroke. Isn’t it better not to wait for catastrophe to strike before deciding to quit?

If you do smoke again (called a relapse), do not lose hope. 75% of those who quit relapse at least once. Most smokers quit three times before they are successful. If you relapse, don’t give up! Review the reasons why you wanted to become a non-smoker. Plan ahead and think about what you will do next time you get the urge to smoke.

Information Sources: Cleveland Clinic Health Bulletin, About.com smoking cessation, Upendra Kaul’s published studies, Inter Heart data

Prof. Upendra Kaul, Founder Director Gauri Kaul Foundation