Tobacco and Heart Disease

Dr Dharmakanta Kumbhakar

(The writer may be reached at drkdharmakanta@yahoo.com)

According to the World Heath Organization (WHO), cardiovascular disease (CVD) is the leading cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 12% of all heart disease deaths. Tobacco use is the second leading cause of heart disease, after high blood pressure. Despite the known harms of tobacco to heart health, and the availability of solutions to reduce related death and disease, knowledge among large sections of the public that tobacco is one of the leading causes of CVD is low. That is why, this year, World No Tobacco Day is focusing on the important link between tobacco and heart disease, adopting the campaign theme “Tobacco and heart disease”. The campaign aims to increase awareness on the link between tobacco and heart and other cardiovascular diseases, and promote feasible actions and measures that key audiences, including governments and the public, can take to reduce the risks to heart health posed by tobacco.

Tobacco increases the risk of developing CVD, which includes coronary heart disease (CHD), heart attacks, hypertensive heart disease, stroke, peripheral arterial disease (PAD), etc. Whether the tobacco is chewing or smoking, tobacco damages blood vessels, temporarily raises blood pressure and lowers exercise tolerance. Tobacco increases the tendency for blood to clot. Blood clots in the arteries can further cause a range of heart problems, which ultimately result in a stroke or sudden death. Chewing tobacco or snuff may be less dangerous than smoking tobacco, but eventually after long term use they lead to grave heart health problems too.

Smoking tobacco, including cigarettes, cigars and pipes, and shisha (hookah), has a devastating impact on our cardiovascular health. Smoking tobacco actually triples the risk of dying from heart disease. Every cigarette we smoke and/or every session of shisha we do, make us more likely to get heart disease. The WHO points that the total volume of smoke inhaled during an hour-long session of shisha is equivalent to smoking 100 to 150 cigarettes. About 30% of all heart disease deaths worldwide are directly related to tobacco smoking. Contrary to public perception, smoking-caused heart disease actually results in more deaths per year than smoking-caused lung cancer. When it comes to heart disease prevention, no amount of smoking is safe. Even smoking occasionally increases the risk of heart disease. People who quit smoking dramatically reduce their risk of dying from heart disease. The body begins to repair itself almost immediately. No matter how long or how much one smoked, will start reaping rewards as soon as one quits. Quitting smoking can help people who already have heart disease. People who quit smoking can cut their risk of having another heart attack or dying of heart disease in half. When a smoker quits, the risk of heart disease death begins to fall almost immediately, but it takes 15 years for the risk to approach that of a non-smoker.

Tobacco smoke contains high levels of carbon monoxide, which in turn affects the heart (increase in heart beat) by reducing the amount of oxygen the blood can carry to the other parts of the body. The nicotine present in the tobacco smoke causes an increase in heart rate and blood pressure. Over time, these cause extraordinary “wear and tear” on the cardiovascular system. Chemicals in tobacco smoke can form atherosclerosis in coronary arteries, leading to narrowing of the coronary arteries and thus restrict the blood flow to the heart. Atherosclerosis makes heart work harder, increasing heart rate and blood pressure to get sufficient oxygen and nutrition. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle-Myocardial infarction) may occur. Cigarette smoking is a multiplicative risk factor with hypertension and hypercholesterolemia for development of CHD and arteriosclerosis.

It is also a multiplicative risk factor for myocardial infarction (MI) and stroke in women who take oral contraceptives. Cigarette smoking is a major cause of stroke by activating clotting factors, decreasing HDL cholesterol levels, increasing triglyceride levels, and damaging the lining of blood vessels. Smoking tobacco causes thrombus formation by increasing platelet adhesion and aggregation, and so PAD which can impact blood circulation, particularly to hands and feet, and result in gangrene, and eventually amputation. In addition to the heart health hazards of mainstream tobacco smokes, there are risks associated with exposure to side stream smoke, also called passive smoking or environment tobacco smoke (ETS). Research shows that ETS increases the risk of ischemic heart disease and MI. Non-smokers living with and around smokers have a 30% more risk of acquiring heart disease.

The burden of tobacco-related heart disease and death is high in India also. There is a significant economic burden in India due to resources invested in healthcare to treat tobacco-related heart diseases. Besides the treatment related expenditure, the indirect cost due absence from work, premature death loss of working family member constitute a greater burden of the nation. Smoking is now the most identifiable risk factor for heart attacks among the young people in India. A report of the AIIMS, New Delhi indicates that 76% of young heart attack victims are smokers in India. As tobacco-related heart diseases are preventable by quitting tobacco consumption, the Government and NGOs should offer medical (such as nicotine replacement therapy, behavioural therapy, etc.) and social help to the smokers to quit tobacco smoking. If intensive support is combined with pharmacological aids, quit rates are significantly high. Moreover, one should try oneself to quit smoking to get rid of tobacco-related heart disease and death. The government must protect people from exposure to tobacco smoke by creating completely smoke-free indoor public places, workplaces and public transport. The government should implement harsh anti-tobacco laws, ban on tobacco advertising/promotion/sponsorship, increase tax on tobacco to make them less affordable, regulate the sale of tobacco, implement plain packaging and/or prominent and 85% pictorial health warnings on tobacco packaging, and start more campaigns focusing on the health hazards of tobacco consumption and highlighting the bountiful benefits once the habit is kicked.