While advancements have been made in the field of tobacco-related research, smoking cessation rates have slowed in recent years, showing that there is still need for greater understanding of the cardiovascular effects of cigarette smoke exposure and electronic cigarettes, according to a council perspective from ACC’s Prevention of Cardiovascular Disease Section Leadership Council and Early Career Council published Sept. 14 in the Journal of the American College of Cardiology.

In the review, Pamela B. Morris, MD, FACC, chair of the Prevention of Cardiovascular Disease Section Leadership Council, et al., focus on tobacco-related issues and their consequences on cardiovascular health. They note that while there was a significant reduction in daily smoking from 1980 to 2012, the total number of smokers worldwide increased during this period, from 721 million to 967 million, as a result of population growth. Exposure to cigarette smoke and second hand smoke causes 6.3 million deaths per year. There have been significant advances in the understanding of the effect of smoking, but the pace of new research has slowed in recent years. At the same time, new tobacco-related products have continued to be developed more quickly than research on their effects has been performed. Cessation rates have slowed, possibly due to residual addiction or fatigue from anti-smoking messaging, they explain.

They note that exposure to cigarette smoke causes many cardiovascular issues including an increase on myocardial oxygen demand, higher risks of developing coronary heart disease, myocardial infarction (MI) and stroke. The risk of developing heart failure is 33 percent to 93 percent higher in those that use all types of tobacco products. Smoking is also the most important risk factor in the development of peripheral artery disease (PAD).

According to the authors, smoking cessation has been proven to lower the risks of cardiovascular events, overall mortality, stroke, aortic disease and PAD. They add that smoke-free legislation has shown to reduce rates of acute-MI and coronary heart disease events. In addition, the greatest risk reduction has been seen in nonsmokers and younger people, and reduction risk has been greatest with smoking bans in indoor places and workplaces compared with partial restrictions.

Further, the evolution of electronic cigarettes has come with claims of health benefits, but there are still concerns regarding lung and cardiovascular diseases, as smokeless tobacco users still take in as much nicotine as cigarette smokers, the authors explain. They add that it is important for future research to determine whether the types of particles in electronic cigarettes have the same toxicity as those in ambient air and conventional cigarettes, which have demonstrated to have adverse cardiovascular and respiratory effects.

They conclude that even with advances in research and legislation, cessation rates have slowed. According to the authors, in order to further reduce morbidity and mortality from tobacco use, “it is essential to pursue knowledge of the effects of cigarette smoke exposure on the cardiovascular system at a molecular level, to use genetic/epigenetic and mechanistic insights to develop effective therapeutic and preventive modalities for treatment of smoking behavior, and to continue development of effective and targeted public health strategies to discourage smoking initiation and encourage smoking cessation.”

“This review reminds the cardiology community of the significant improvement in cardiovascular health that has been achieved with smoking cessation interventions in the last several decades,” says Mark Urman, MD, FACC, a member of the ACC’s Prevention Section. “However, much more can and still needs to be done to further diminish the deleterious cardiovascular effects of smoking and second-hand smoke exposure.”

Listen to an audio commentary by Valentin Fuster, MD, PhD, MACC. 

Keywords: Aortic Diseases, Behavior, Addictive, Electronic Nicotine Delivery Systems, Risk Factors, Risk Reduction Behavior, Smoking, Smoking Cessation, Tobacco Smoke Pollution

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