Contents
The components of tobacco smoke damage blood vessels and are one of the most serious risk factors for coronary heart disease and other cardiovascular diseases.
Cardiovascular diseases are still the most common cause of death in Poland, despite enormous progress in their treatment. Therefore, a lot of emphasis has been placed on the prevention of these diseases for many years. Its effectiveness is determined by the elimination of risk factors for heart and circulatory system diseases. They can be divided into two groups: modifiable factors, i.e. those which we have influence and which depend on our lifestyle, and non-modifiable factors: age, sex, race and genetic predisposition to cardiovascular diseases.
There are more modifiable factors. It has been proven in many studies that cardiovascular diseases are promoted by: smoking, hypertension, high LDL cholesterol, low HDL cholesterol, elevated glucose levels, obesity, sedentary lifestyle, high-fat diet and stress.
quit smoking
Cigarette addiction to nicotine is a risk factor for many diseases. This addiction accounts for 20 percent of cardiovascular deaths and 30 percent of cancer deaths. And yet it is only up to us whether we stop using cigarettes. Worse still, passive smoking is also a risk factor for serious disease, accounting for 8 percent of all smoking-related deaths. In contrast, quitting smoking has clear benefits. After just one year of abstinence, the risk of dying from coronary heart disease is 50 percent lower than in a person who continues the addiction.
In the 80s, the frequency of smoking in Poland was one of the largest in the world – 15 million Poles (80% of men and 50% of women) smoked. Due to such a large number of smokers, it did not take long to see the health effects of this addiction. The number of illnesses caused by smoking has started to increase rapidly. As early as the 60s and 70s, more men aged 30-60 died each year than in the previous year. The only explanation for this was the increasingly common addiction to smoking. Fortunately, this situation has been gradually improving over the past 15 years, as the fashion for not smoking is beginning to reach Poland as well. However, many people still smoke, and more and more women, teenagers and even children are among them. Therefore, it is worth being aware of what happens in the body under the influence of nicotine smoke.
Poisonous mixture
Tobacco smoke is a mixture of over 4000 different chemical compounds. A cigarette smoked within 10 minutes provides about 50 ml of smoke, which includes: nicotine, carbon monoxide, tar, large amounts of oxygen free radicals and many other substances. All of these factors play a large role in causing the health problems associated with smoking addiction. Smokers are at increased risk for many of the most serious diseases, including cardiovascular disease: heart attacks, strokes, and lower extremity atherosclerosis. Most likely, nicotine and carbon monoxide are the main toxicants in the vascular system. The toxins from tobacco smoke damage the walls of the vessels and narrow their diameter, which in turn obstructs blood flow and forces the heart to work excessively. The substance responsible for this process is nicotine, and the constriction of the vessels increases the risk of blood clots. The main blood clotting factors “blamed” for the progression of the prothrombotic state are: increased levels of fibrinogen (Fb) and von Willebrand factor (vWF). Fibrinogen is a plasma protein that is involved in the blood clotting process. Too high levels make the blood sticky and make it difficult to flow through the blood vessels, which promotes clots that can block the arteries.
Studies conducted at the Atherosclerosis Research Center of the Pomeranian Medical University in Szczecin have shown higher Fb levels in smokers compared to non-smokers, especially in people with hypertension compared to people with normal blood pressure. This group of patients is at increased risk of heart attack and stroke.
According to prof. Marek Naruszewicz from the Regional Center for Research on Atherosclerosis in Szczecin, the increased concentration of Fb in tobacco smokers is a phenomenon confirmed by the results of population studies. Studies: ARIC (989 participants, USA), Caerphilly Study (2188 participants, UK), Edinburgh Artery (1592 participants, Scotland) showed a close relationship between smoking habit and elevated Fb levels and an increased risk of coronary and peripheral arteriosclerosis. Recent population studies show that increased Fb levels in smokers are associated with increased aggregation of platelets, which are cells of key importance in the development of early atherosclerotic lesions of the coronary arteries. Evidence of the increased activation of platelets in tobacco smokers is also the observed increase in the concentration of von Willebrand factor (vWF), a sensitive marker of endothelial dysfunction. The strong influence of smoking on the activation of platelets is demonstrated by the fact that a significant increase in vWF concentration is noted even 10 minutes after smoking a cigarette.
Smoking is more harmful to women
Despite the prevailing fashion for a dozen or so years for non-smoking and the restrictions introduced in various countries in relation to smoking, there are still many supporters of this addiction. The latest statistics from the World Health Organization (WHO) show that there are currently around 1,1 billion tobacco smokers in the world, one fifth of whom are women. Every year, smoking is the direct cause of over 5 million deaths, including 1,5 million of women. Even more alarming are the forecasts according to which, if the current model of smoking continues, in 2030 the number of female smokers will increase significantly, reaching 8 million, and the number of deaths during this period may even reach 2,5 million. This ever-increasing proportion of women smoking tobacco has prompted the cardiologist community to undertake an overarching study of gender-related research on coronary heart disease risk in smokers. Of the 8005 abstracts of the prospective studies published between January 1, 1966 and December 31, 2010, 26 articles were finally analyzed.
These studies involved over 2,4 million people from several continents and many countries, analyzed more than 44000 cases of coronary artery disease in both sexes and compared them. The summary of the meta-analysis shows unequivocally that compared to non-smokers, female smokers have a 25 percent greater risk of developing coronary heart disease than male smokers, regardless of other cardiovascular risk factors. That is why it is so important to protect smokers, especially young women – potential mothers, from the adverse effects of tobacco on the development of coronary artery disease. Unfortunately, no answer has been found as to whether age influences the gender gap between smokers and the risk of coronary heart disease.
Nicotine replacement therapy in the hospital
Hospitalization for an acute heart attack (AMI) is a landmark event for many people and can be a turning point in the process of quitting smoking. The results of the research conducted so far show that attempts to quit smoking during hospitalization due to ischemic heart disease are more effective than those undertaken in other circumstances. It has been observed that pharmacotherapy, initiated while still in hospital, gives a greater chance of success in the fight against addiction compared to counseling alone. Using nicotine replacement therapy (NRT) reduces symptoms of nicotine withdrawal, supports abstinence in the hospital and increases the willingness of smokers to maintain it. Two US clinical trials have shown that NRT does not increase the risk of cardiovascular events in patients with stable coronary artery disease. Despite these results, many US physicians are reluctant to prescribe NRT during hospitalization after an acute heart attack. The observed differences in hospital care may reflect the lack of a sense of the importance of smoking cessation, uncertainty / ignorance of the use of pharmacotherapy or concerns about the safety of such treatment. National (Polish) guidelines recommend that care should be taken to ensure that inpatients receive counseling to help them quit smoking.
Therapeutic SMS
Effective smoking cessation assistance programs are being sought around the world. An interesting study in this field was carried out in Great Britain. It assessed the impact of SMS messages sent to smoking patients encouraging them to stop smoking. The study lasted 6 months. The inclusion criteria for participation in the study were: age over 16 and declared willingness to quit smoking within the next month from the date of inclusion in the study, as well as having a mobile phone. The analysis included 11 patients, of which 914 met the inclusion criteria. Selected people were randomly assigned to groups – intervention (5800 patients) and control (2911 people). The groups were comparable in terms of sex, age, education, work performed and the strength of nicotine addiction as measured by the Fagerstrom scale. During the course of the study, patients could freely use other smoking cessation support programs. Subjects were asked to set a quit smoking date within 2881 weeks of being randomly assigned to one of the groups. For the first 2 weeks they received 5 SMS messages a day, then for 5 weeks they received 26 SMS messages a week. The content of the messages sent was developed in cooperation with specialists from anti-smoking clinics, as well as with the participation of smokers. Messages sent to patients from the intervention group were intended to encourage participants to persevere in breaking the addiction and to focus their attention on the success they have achieved so far. They were also used to highlight the benefits of quitting smoking and to inform about the effects of the addiction. Text messages encouraged people to get rid of cigarettes, ashtrays and lighter at home, and to avoid places where there is cigarette smoke. The respondents were also encouraged to describe the difficulties encountered and plan ways to overcome them. The use of a hotline for smokers and nicotine replacement therapy was also promoted.
Summarizing the results of the study, it was found that supporting the motivation to quit with SMS messages doubled the percentage of non-smokers after the 6-month follow-up. Therefore, this method of therapy can be considered effective. Its advantages are: accessibility (widespread use of mobile phones) and low price. The study draws attention to a very interesting methodology, but there is no explanation of the mechanism of operation of the method used.
Text: Barbara Skrzypińska
The ABC of a healthy heart