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

Authors and Disclosures

Christopher Bullen, Clinical Trials Research Unit, School of Population Health, The University of Auckland, Private Bag 92019, Auckland, New Zealand. c.bullen@ctru.auckland.ac.nz

Sidebar: Key Issues

Smoking is arguably the most important preventable cause of cardiovascular disease globally.

Smoking acts synergistically with other cardiovascular risk factors to increase the risks of myocardial infarction, sudden cardiac death, stroke, peripheral vascular disease and aortic aneurysm.

The pathophysiology of smoking-induced cardiovascular disease is complex but it now appears that oxidative stress induced by toxins in cigarette smoke plays the central role in the development of both smoking-induced thrombosis and atherosclerosis.

Smoking cessation leads to an almost immediate reduction in the risks of cardiac events. Over time, most of the cardiovascular risk induced by tobacco smoking is reversible.

Even small exposures to tobacco smoke can triggeracute cardiac events. Therefore, complete cessation and avoidance of second-hand smoke exposure is important, especially for patients with established disease.

Smoking cessation treatments are safe in almost all circumstances, including in the context of acute cardiovascular disease events. They are also highly cost effective and can more than double the chances of a successful quit attempt.

Physicians have a responsibility to ensure that every smoker under their care, in particular those at high risk of cardiovascular disease, receives appropriate cessation treatment and support.

Physicians also have an important role as advocates for wider tobacco control initiatives that offer both individual and population benefits, such as legislation that promotes smoke-free workplace and recreational environments.

Sidebar: Website

201 Medicines and Healthcare products Regulatory Agency. Report of the Committee on Safety of Medicines Working Group on Nicotine Replacement Therapy. MHRA, Committee on Safety of Medicines. www.mhra.gov.uk/home/idcplg?IdcService= GET_FILE&dDocName=CON2023239&RevisionSelectionMethod= LatestReleased (Accessed 3 July 2006).