Smoking, a major risk factor for cardiovascular diseases

In a recent article, the British organization Action for Smoking and Health (ASH)[1] recalls the heavy burden of cardiovascular diseases (CVD) and the contribution of smoking to the development of these diseases. CVD is responsible for approximately 4.1 million deaths each year in European countries[2].

Cardiovascular diseases (CVD) include coronary artery disease (angina and myocardial infarction), cerebrovascular disease (ischemic and hemorrhagic stroke), heart valve disease, congenital heart disease, and peripheral artery disease.[3]Among these, coronary artery disease and stroke are the leading causes of death worldwide and a major contributor to disability. Smoking is the main risk factor.

The burden of cardiovascular disease

CVD is the leading cause of death worldwide. It causes 31% of premature deaths, and these numbers are increasing every year. In 2019, CVDs were responsible for approximately 19 million deaths worldwide, 9.8 million men and 9.2 million women. The annual global number of deaths from CVD is expected to reach more than 23 million by 2030 and more than 34 million by 2060.

Each year, out of 9.4 million deaths from coronary artery disease, 1.9 million, or 20%, are attributable to smoking and exposure to second-hand smoke.[4]In the WHO European Region, where the average adult smoking rate is 26%, one in five deaths from coronary artery disease was due to smoking in 2017, representing an estimated 480,000 lives lost.[5].

In France, CVDs cause around 140,000 deaths per year, or nearly 400 deaths per day.[6]Of the 75,000 deaths attributable to tobacco, 16,000 are due to CVD, or more than one in five deaths.[7]. CVDs have long been the leading cause of death in the country, but in recent years they have become the second leading cause of death after cancer, due to a continued decline in the number of cardiovascular deaths linked to improvements in prevention and therapeutic management. Nevertheless, in those over 65 and in women, these diseases remain the leading cause of death. CVDs account for 30% of female deaths, and an increase in the rate of women under 65 hospitalized for MI was observed between 2008 and 2013, particularly among those aged 45-54 (+4.8% per year).[8]This development should be compared with the specific development of female smoking in these age groups in France.[9].

Smoking, the main modifiable risk factor for CVD

It has been shown that the risk of CVD is significantly higher in current smokers, compared to people who have never smoked and those who have quit smoking. Smoking increases the risk of death from CVD by up to three times. This impact of smoking is also present in younger people. Thus, 80% of myocardial infarction victims before the age of 45 are smokers and between the ages of 30 and 49, the risk of myocardial infarction in smokers is multiplied by five.[10]Tobacco use also increases the risk of developing high blood pressure, atherosclerosis, arteritis of the lower limbs, or a stroke.

A systematic review investigating the impact of smoking on CVD in older adults found that among those aged 60 and older, smoking still significantly contributes to acute coronary events, stroke, and doubles the risk of cardiovascular death. In this analysis, smoking advanced the risk of dying from cardiovascular disease by 5.5 years.[11].

The impact of smoking cessation on the development and mortality of CVDs

Quitting smoking completely significantly reduces the risk of developing CVDs, including myocardial infarction, stroke, and lower limb arteritis. A cohort study of 8,770 people showed that among heavy smokers, smoking cessation was associated with a significantly lower risk of CVD within 5 years compared to current smokers. About 10 to 15 years after quitting, former smokers had a CVD risk similar to that of nonsmokers.[12].

The health benefits of quitting smoking are very rapid, and contrary to popular belief, there is no threshold below which smoking is considered safe. Thus, the risk exists even with the consumption of one cigarette per day.[13]. The duration of smoking is a determining factor. Therefore, quitting smoking as early as possible is a priority objective, considerably reducing the risks of contracting CD. Nevertheless, benefits exist at any age, since at 60 years of age, quitting smoking still allows you to gain, on average, 3 years of life expectancy. [14]Beyond the impact on life expectancy, quitting smoking is also an essential factor in preventing the recurrence of cardiovascular accidents. Thus, smokers who stop smoking after a myocardial infarction reduce their risk of death by 36% and their risk of a new infarction by 32%.[15].

  Keywords: Cardiovascular diseases, CVD, heart, smoking, health, prevention, smoking cessation ©Generation Without Tobacco

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[1] Smoking, the heart and circulation, Action for Smoking and Health, August 4, 2021, accessed August 5, 2021 [2] Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D. European Society of Cardiology: cardiovascular disease statistics 2019. European heart journal. 2020 Jan 1;41(1):12-85. [3] World Health Organization (WHO). Factsheet: Cardiovascular Diseases. June 11, 2021, accessed August 5, 2021 [4] WHO press release, Tobacco responsible for 20% of deaths from coronary heart disease, September 22, 2020, accessed August 5, 2021 [5] WHO press release, More than 20% of coronary heart disease deaths are linked to smoking and secondhand smoke exposure, September 20, 2020, accessed August 5, 2021 [6] Figures from the Ministry of Solidarity and Health, Cardiovascular diseases, last updated August 2, 2021, accessed August 5, 2021 [7] Christophe Bonaldi, Marjorie Boussac, Viet Nguyen-Thanh, Estimated number of deaths attributable to smoking in France from 2000 to 2015, Public Health France, March 15, 2019, no. 15, p. 278-284. http://beh.santepubliquefrance.fr/beh/2019/15/2019_15_2.html [10] From 1 cigarette a day, heart and arteries in danger, French Federation of Cardiology, May 28, 2018, consulted on August 5, 2021 [11] Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, de Groot L, Freedman ND, Jansen E, Kee F, Kromhout D. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. bmj. 2015 Apr 20;350. [12] Duncan MS, Freiberg MS, Greevy RA, Kundu S, Vasan RS, Tindle HA. Association of smoking cessation with subsequent risk of cardiovascular disease. Jama. 2019 Aug 20;322(7):642-50. [13] Hackshaw A, Morris JK, Boniface S, Tang JL, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018 Jan 24;360:j5855. doi:10.1136/bmj.j5855. Erratum in: BMJ. 2018 Apr 11;361:k1611. Erratum in: BMJ. 2018 Nov 28;363:k5035. PMID: 29367388; PMCID: PMC5781309. [14] Blake Thomson, Jonathan Emberson, Ben Lacey, Richard Peto, Mark Woodward, and Sarah Lewington, Childhood Smoking, Adult Cessation, and Cardiovascular Mortality: Prospective Study of 390,000 US Adults, Journal of the American Heart Association. October 28, 2020, https://doi.org/10.1161/JAHA.120.018431 [15] Critchley JA, Capwell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease. A systematic review. JAMA 2003;290:86–97 National Committee Against Smoking |