Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease

Christopher Bullen


Expert Rev Cardiovasc Ther. 2008;6(6):883-895. 

In This Article

Abstract and Introduction


Despite declines in smoking prevalence in many Western countries, tobacco use continues to grow in global importance as a leading preventable cause of cardiovascular disease. Tobacco smoke is both prothrombotic and atherogenic, increasing the risks of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease. Even very low doses of exposure increase the risk of acute myocardial infarction. However, smoking cessation and second-hand smoke avoidance swiftly reduce this risk. While promising new agents are emerging, proven cost-effective and safe cessation interventions already exist, such as brief physician advice, counseling and nicotine replacement therapy. These should be routinely offered, where available, to all smokers. This is especially important for those at risk of, or with established and even acute, cardiovascular disease. Clinicians must play a more active role than ever before in supporting complete cessation in patients who smoke and in advocating for stronger tobacco control measures.


Tobacco smoking is arguably the most important preventable cause of cardiovascular disease.[1,2] In the year 2000, 1.62 million deaths – more than one in every ten cardiovascular deaths in the world – were attributable to tobacco smoking, with 1.17 million of these among men and 450,000 among women.[1] Coronary heart disease accounted for 54% of smoking-attributable cardiovascular mortality, followed by cerebrovascular disease (25%), although there is regional variation in the role of smoking as a cause of various cardiovascular diseases.[1,2] In the USA alone, smoking is estimated to cause around 140,000 premature deaths from cardiovascular disease annually.[2]

Prospects for improvement in this picture are not encouraging. Of the predicted 1 billion tobacco-related deaths in the 21st Century, 30–45% will be due to the cardiovascular effects of smoking.[2] Many of these premature deaths will occur in Asia, where the majority (53%) of the world's 1.1 billion smokers currently reside and where the prevalence of smoking is increasing, in contrast to a stable or declining prevalence in most of the developed world.[3]

In light of the ongoing toll from tobacco smoking in the West, and the impending epidemic of cardiovascular disease in low- and middle-income countries, efforts to address tobacco-related harm need to be redoubled. Fortunately, an unprecedented investment of philanthropic funding is being directed towards initiatives that will support the early adoption of the components of the Framework Convention for Tobacco Control (FCTC) in growing economies such as China, Brazil and India. Most recently, the WHO has launched the MPOWER strategy for global tobacco control,[4] a key element of which is treatment to help smokers stop smoking. This paper reviews the current evidence for the links between tobacco smoking and cardiovascular disease, identifies the cardiovascular benefits of smoking cessation, and summarizes current best practice and future directions in cessation of smoking treatment. In line with the renewed mandate from the WHO, it argues for a far more active role for clinicians in both treating patients and advocating for stronger tobacco control measures, locally and globally, than has been the case to date.


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