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Posted at: May 13, 2017, 12:47 AM; last updated: May 13, 2017, 12:47 AM (IST)WELLNESS

Death by smoke

Smoking causes 30 per cent of all heart disease deaths. Time to kick the butt

Zile Singh Meharwal

A Supreme Court directive last year made it mandatory for manufacturers of tobacco products to display large visual warnings that cover 85 per cent of the packet surface. The directive could not have come sooner as smoking has emerged as a major culprit responsible for coronary heart diseases (blockages in arteries), one of the leading causes of death in India.

Smoking-caused heart diseases result in more deaths per year than smoking-caused lung cancer. Thirty per cent of all heart disease deaths are caused by cigarette smoking, making it the single largest preventable cause of heart disease. In India, smoking is prevalent in many forms like cigarette, bidi and hookah smoking. Besides there is more tobacco intake like chewing it in forms of khaini, jarda etc. Tobacco in all forms is harmful for the cardiovascular system.

Tobacco smoke affects the heart through multiple means. It contains high levels of carbon monoxide, which affects the heart and other organs by reducing the amount of oxygen the blood is able to carry. Not just the heart, but lungs, brain, and other vital organs, too, do not receive enough oxygen. Simultaneously, nicotine also causes increase in heart rate and blood pressure. Over time, this causes extraordinary “wear and tear” on the cardiovascular system and vascular endothelium i.e. the inner lining of blood vessels. People who use tobacco are more likely to have heart attacks, high blood pressure, blood clots, strokes, hemorrhages, aneurysms, and other disorders of the cardiovascular system.

Smoking actually triples the risk of dying from heart disease. Cigarette smoking is a major cause of stroke by increasing clotting factors in the blood, decreasing HDL (good cholesterol) levels, increasing triglyceride levels, and damaging the lining of blood vessels. The risk for stroke increases as the number of cigarettes smoked increases. Light smoking (1-4 cigarettes a day) causes an increase in coronary artery disease up to 11 per cent compared to only 3.7 per cent for nonsmokers. Smoking increases the risk of stroke by 40 per cent in men and 60 per cent in women.

And it is not only the direct smoking that increases the risk of heart and other related diseases. Second hand smoke is equally harmful. It is a combination of the smoke produced by the burning end of a cigarette, pipe, or cigar and the smoke exhaled from the lungs of smokers. This mixture contains more than 4,000 substances, more than 40 of which are known to cause cancer in humans or animals.

In fact, long-term exposure to second hand smoke can cause a 30 per cent increase in the risk of heart disease in nonsmokers.

Exposure to second hand smoke also negatively affects cardiovascular health by decreasing exercise endurance, damaging blood vessel walls, and increasing the tendency of blood platelets to clot, contributing to heart attacks. Also, nonsmokers’ bodies tend to react more dramatically to tobacco exposure than do smokers’ bodies. So even lower levels of smoke can cause adverse effects.

Quitting smoking can help in reducing the risks of cardiovascular diseases in those persons smoking for a long time. People who quit smoking dramatically reduce their risk of dying from heart disease. Quitting also helps people who already are suffering from heart disease. People who quit cut their risk of having another heart attack or dying by 50 per cent but it takes ten years for the risk to approach that of a nonsmoker. Quitting also reduces the risk of other circulatory diseases. People who quit decrease their risk of abdominal aortic aneurysm in half. The risk of stroke or hemorrhage is also reduced.

As soon as a person quits smoking, his/her body begins to get better immediately. Within a few weeks, exercise endurance and cardiovascular capacity improve, and HDL increases.

Most studies of cigar and pipe smokers reveal lower lung cancer and cardiovascular risks as compared with cigarette smokers. Former smokers who smoked only pipes or cigars show an intermediate risk of lung cancer when compared to current smokers who show a higher risk. However, pipe and cigar smokers show a higher risk of lung cancer than those who have never smoked.

Many cigar and pipe smokers justify smoking a pipe or cigar by claiming they do not inhale. They may puff small amounts of smoke because pipes and cigars are much stronger in terms of nicotine than the average cigarette, and it is painful to the chest to inhale large amounts of pipe or cigar smoke. Pipe and cigar puffers do not need to inhale because these tobaccos have a much higher pH than cigarettes. Because of the higher pH, the user of these products needs to only hold the smoke in the mouth for absorption of nicotine to occur. Cigar and pipe smoking may be slightly safer than cigarette smoking but these are not safe.

A smokeless tobacco (snuff and chewing tobacco) user is exposed to more nicotine than the typical cigarette smoker. The average cigarette contains approximately eight to 11 mg of nicotine, but what the smoker ingests is 0.5 to 1.5 mg of nicotine (a cigarette averages one mg). The average pinch of smokeless tobacco is 2.5 gm.

In a study published this year in a medical journal about the harmful effects of second hand smoking among hookah workers at a bar, the researchers found that the levels of carbon mono oxide and other related harmful components in the blood of these workers were as high as heavy cigarette smokers placing them at the same risk for cardiovascular and other smoke related disease as heavy smokers. This study decimated the myth that hookah smoking is safe and the water in the hookah absorbs the harmful smoke components.


Put an end to fag

Smoking increases the risks for the following diseases: 

Ischemic heart disease 

Pulmonary heart disease 
Cardiac arrest 

Cerebrovascular disease

Aortic aneurysm

—The writer is Director & Coordinator, Department of Cardiovascular Surgery, Fortis Escorts Heart Institute


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