What are the pros and cons of smoking?

Smoking Has No Medical Benefits and Causes Devastating Health Consequences

There are no legitimate "pros" to smoking from a medical standpoint—smoking is the single most preventable cause of disease and premature death, responsible for approximately 440,000 deaths annually in the United States alone, with overwhelming evidence demonstrating catastrophic effects on morbidity, mortality, and quality of life across all organ systems. 1

Overwhelming Evidence of Harm

Mortality Impact

• Smoking causes 50% of all avoidable deaths in smokers, with half of these deaths due to cardiovascular disease 1
• Approximately 30% of all cancer deaths in the United States are directly attributable to active smoking 1
• Nearly 20% of all cardiovascular disease deaths are caused by tobacco use, including more than 148,000 deaths from active smoking and an additional 35,000 deaths from secondhand smoke exposure 1
• Smoking reduces life expectancy and increases overall medical costs while contributing to loss of productivity 2

Cardiovascular Disease

• The 10-year fatal cardiovascular risk is approximately doubled in smokers, with the relative risk of myocardial infarction in 50-year-old smokers being five-fold higher than in non-smokers 1, 3
• Patients with established coronary artery disease who continue smoking face a 55% increased risk of death and more than double the risk of sudden cardiac death compared to those who quit 3
• Smoking enhances both the development of atherosclerosis and the occurrence of superimposed thrombotic phenomena through endothelial dysfunction, oxidative stress, and inflammation 1, 4

Cancer Risk

• Cigarette smoking causes an estimated 85-90% of lung cancer deaths 1
• Tobacco smoking is causally related to at least 16 types of cancer, including lung, colon, rectum, oral cavity, nasal cavities, pharynx, larynx, esophagus, stomach, pancreas, liver, urinary bladder, kidney, uterine cervix, and myeloid leukemia 1
• Environmental tobacco smoke is responsible for an additional 3,000 lung cancer deaths among nonsmokers annually 1

Metabolic Disease

• Smoking is an independent and modifiable risk factor for the development of type 2 diabetes 1
• Men and women who smoked 2 packs per day had a 45% and 74% (respectively) higher diabetes mellitus incidence rate than those who had never smoked 1
• Tobacco use exacerbates the complications of diabetes and is associated with worse glycemic control 1

Respiratory Disease

• Cigarette smoking is the single most important risk factor for chronic obstructive pulmonary disease (COPD) 5
• Smoking is associated with lower levels of FEV1, increased respiratory symptoms, and more frequent respiratory infections 5
• For COPD patients, cessation is the only evidence-based intervention that improves prognosis by mitigating lung function decline 1, 6

Dose-Response Relationship with No Safe Level

• The risk associated with smoking shows a clear dose-response relationship with no lower limit for deleterious effects 1
• All types of smoked tobacco are harmful, including low-tar ("mild" or "light") cigarettes, filter cigarettes, cigars, pipes, and waterpipes 1
• Even substantial smoking reduction (>50% reduction in cigarettes per day) decreases lung cancer risk but does not eliminate it, and the magnitude of risk remains high 7

Passive Smoking

• A non-smoker living with a smoking spouse has an estimated 30% higher risk of cardiovascular disease 1, 3
• Exposure to environmental tobacco smoke in the workplace is associated with similar risk increments 1
• Passive smoking increases the risk of coronary heart disease with a higher relative risk than might be expected 1

Addressing the Misleading Concept of "Benefits"

While one research paper 8 mentions theoretical associations between nicotine and certain conditions (Parkinson's disease, ulcerative colitis, etc.), this does not constitute a medical "pro" of smoking. The paper itself acknowledges smoking as "one of the greatest causes of avoidable illness and death in the modern world" and suggests studying mechanisms only to develop therapeutic alternatives—not to justify smoking 8.

Economic Considerations Are Not Medical Benefits

• While tobacco generates tax revenue and employment, these economic activities do not offset the massive health and economic costs 9
• The direct costs of smoking to healthcare systems are enormous: approximately 15% of aggregate healthcare expenditure in high-income countries can be attributed to smoking 9
• In the UK, direct costs to the NHS are estimated at £2.7-5.2 billion annually, equivalent to 5% of the total NHS budget 9
• The economic burden of smoking accounts for approximately 0.7% of China's GDP and 1% of US GDP 9

Benefits of Smoking Cessation (The Only Medically Sound Recommendation)

Immediate and Progressive Benefits

• Smoking cessation produces almost immediate cardiovascular benefits, with significant morbidity reductions within the first 6 months 1, 6
• Blood carbon monoxide levels normalize within hours to days, immediately improving oxygen delivery to tissues 6
• Stroke risk decreases by 50% within the first year of cessation 6
• Endothelial function, oxidative processes, platelet function, fibrinolysis, inflammation, and vasomotor function begin to normalize within a very short time after cessation 6

Long-Term Risk Reduction

• Stopping smoking after a myocardial infarction is potentially the most effective of all preventive measures, with a mortality benefit of 0.64 (95% CI: 0.58-0.71) compared with continued smokers 1
• Among people who quit smoking, the risk of death from coronary heart disease is 50% lower than that of people who continue to smoke after just 1 year of abstinence 1
• Cardiovascular disease risk approaches that of never-smokers within 10-15 years after quitting 3, 4
• Quitting smoking reduces the incidence of diabetes to that of nonsmokers after 5 years in women and after 10 years in men 1

No Age Limit to Benefits

• There is no age limit to the benefits of smoking cessation 1
• Even individuals in their 50s and 60s, and even patients already diagnosed with cancer, benefit from stopping smoking 1

Clinical Implementation

The "Five As" Approach

Healthcare providers should systematically apply 6:

• Ask about smoking status at every opportunity
• Advise unequivocally to quit
• Assess degree of addiction and readiness to quit
• Assist with a cessation strategy including behavioral counseling and pharmacological support
• Arrange follow-up

Most Effective Interventions

• Combination therapy is most effective: behavioral interventions combined with pharmacotherapy maximizes cessation rates 3
• Pharmacological support (nicotine replacement therapy, varenicline, or bupropion) should be offered following or in addition to behavioral interventions 6
• Even very brief counseling (as little as 3 minutes) can produce long-term quit rates, though longer programs are more effective 1

Common Pitfalls to Avoid

• Never suggest that "light" or reduced smoking is acceptable: Even low levels of smoking confer vascular risk with no safe threshold 1, 3, 7
• Do not ignore passive smoke exposure: Patients must avoid all secondhand smoke, as exposure increases cardiovascular disease risk by 30% 1, 3, 4
• Do not delay cessation interventions: Evidence-based cessation treatments are underutilized, and momentum is particularly strong at the time of diagnosing cardiovascular disease 3
• Never use monotherapy alone: Combining pharmacological and behavioral approaches is significantly more effective than either alone 1, 3

Weight Gain Concerns Should Not Deter Cessation

• Weight gain occurs in >75% of quitters, with mean gains of 2.8 kg in males and 3.8 kg in females 6
• The health benefits of tobacco cessation far outweigh the risks from weight gain, and patients should be counseled accordingly 1, 6
• The long-term cardiovascular benefits of quitting substantially outweigh any risks from modest weight gain 1