From the Guidelines
Smoking is the most significant risk factor contributing to mortality from Cardiovascular Disease (CVD) in a male with all risk factors. This is because smoking directly damages the cardiovascular system through multiple mechanisms, including endothelial dysfunction, increased oxidative stress, enhanced thrombosis, and acceleration of atherosclerosis, as highlighted in the accf/aha/acp 2009 competence and training statement 1. The biochemical and physiological consequences of smoking on CVD are well defined, with compelling evidence demonstrating that smoking cessation is associated with significant reversal of risk for CAD, stroke, and cancer-related deaths 1.
Key Points to Consider
- Smoking causes immediate physiological effects such as increased heart rate, elevated blood pressure, and reduced oxygen delivery to tissues, which can exacerbate the risk of CVD mortality 1.
- The relationship between smoking and CVD mortality is dose-dependent, with heavier smokers facing greater risks, emphasizing the need for prompt and definitive advice to quit 1.
- Smoking cessation can rapidly reduce cardiovascular risk, with some benefits appearing within days to weeks of quitting and substantial risk reduction within 1-2 years, making it a critical component of cardiovascular risk reduction strategies 1.
- Clinical competency in smoking cessation treatment is critical for those whose expertise encompasses primary and secondary prevention of CVD and stroke, including skills in patient education, counseling, and behavioral change, and knowledge of important pharmacotherapies 1.
Management and Prevention
- Identification of smoking status in all patients and implementation of smoking cessation counseling and pharmacotherapies are essential steps in reducing CVD mortality 1.
- Systematic follow-up of all smokers at subsequent visits and the involvement of healthcare professionals with smoking cessation expertise can improve lifetime smoking cessation 1.
- Given the significant economic costs associated with smoking, estimated at $167 billion each year in the United States alone, addressing smoking as a risk factor can have substantial public health and economic benefits 1.
From the Research
Risk Factors for Cardiovascular Disease (CVD)
The most significant risk factors contributing to mortality from CVD include:
- Hypertension: systolic hypertension poses a greater risk than diastolic, but the prognostic significance of diastolic blood pressure may have been underestimated 2
- Cigarette smoking: when a smoker quits, the cardiovascular risk soon approaches that of the nonsmoker 2
- Dyslipidemia: cardiovascular risk increases progressively with elevations of the serum total cholesterol level above 200 mg/dL 2
- Elevated LDL-cholesterol (LDL-C) and triglyceride levels, low HDL-cholesterol levels, type 2 diabetes 3
- Hyperinsulinemia and left ventricular hypertrophy 2
- Abdominal obesity, metabolic factors, and behavioral factors such as smoking 4
Age-Specific Modifiable Risk Factors
Age-specific disparities were observed in the risk factors contributing to CVD, with metabolic factors having the highest population-attributable fraction (PAF) in each age group 4
- Hypertension and abdominal obesity were prominent in all age groups 4
- Smoking was the leading behavioral factor in all age groups 4
- Low income and less education contributed to a higher PAF in certain age groups 4
Prevention Strategies
Preventive strategies against CVDs must be targeted at a primary health promotion level, including: