Cardiovascular disease is a ‘smoking disease’

Cardiovascular disease is an umbrella term which includes all types of diseases affecting the heart or blood vessels. It mainly consists of coronary heart disease (which may present acutely as a heart attack, stroke or heart failure). According to a large study in the United States, at least 1 in 5 male smokers or 1 in 10 female smokers would die earlier due to a cardiovascular disease event.¹ Same group of researchers also found that young smokers (aged between 20 to 40 years old) were at least twice as likely as young non-smokers to die of a heart attack throughout their life.

Smoking is one of the most well-known behavioural risk factors for cardiovascular disease. Thousands of harmful chemicals are contained in cigarette smoke which can lead to multiple adverse health effects. Besides being an addictive compound, nicotine in cigarette smoke may lead to abnormal blood thickening and subsequently, a higher chance of blood clot formation in the major blood vessels. Oxidative damage and narrowing of the blood vessel space may also occur. As a result, a heart attack can happen if a formed blood clot blocks the circulation in a coronary artery (which supplies blood to the heart muscle).

Tobacco use doubles the risk of getting a heart attack.² Co-existence of another major risk factor (such as diabetes, high blood pressure, high cholesterol or obesity) may triple or even quadruple the risk.³ Based on the results of the National Cardiovascular Disease database, around 93% of heart attack patients had at least one of the common cardiovascular risk factors. In the 2018 – 2019 registry report, notably up to 34% of heart attack patients were current smokers, with a worryingly increasing trend of them being active smokers over the two years (from 33.9% in 2018 to 34.5% in 2019).

Quitting smoking cuts the risk of cardiovascular disease dramatically. If a smoker quits smoking and persists to not smoking for 15 years, the risk of coronary heart disease would decrease from that of a non-smoker.⁴ Research has also shown that mortality reduces by 36% for ex-smoker patients with coronary heart disease compared with smokers.⁵ So, if you smoke, you should give it up as soon as possible by seeking professional help at the local Quit Smoking Clinic of designated medical facilities.

It was previously thought that heart attack would affect older adults more often than young adults. Such assumption may not apply fully nowadays as young adults are potentially exposed to similar risk factors of cardiovascular disease. Banning the sale of tobacco products including electronic vaporisers to Malaysians born after January 1, 2007, means that those aged 18 years old (equivalent to the current legal age for smoking) or younger in two years’ time will not be allowed to purchase cigarettes or vaping products legally. This effort, dubbed as ‘Generational Endgame’ by the Ministry of Health Malaysia is commendable to reduce the number of young smokers in Malaysia. Indeed, one of the best things you can do to maintain good cardiovascular health is not to use tobacco in any form (or quit smoking if you do smoke).

This write-up was prepared by Dr Yap Jun Fai (DrPH candidate), Professor Dr Moy Foong Ming and Dr Lim Yin Cheng from the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.

This write-up is also published in the CodeBlue, The Star, NST, and Malaysiakini.

References

1. Khan SS, Ning H, Sinha A, et al. Cigarette smoking and competing risks for fatal and nonfatal cardiovascular disease subtypes across the life course. Journal of the American Heart Association. 2021;10(23):e021751.
   
2. Lakier JB. Smoking and cardiovascular disease. Am J Med. 1992;93(1a):8s-12s.
   
3. Centers for Disease Control and Prevention (US). How tobacco smoke causes disease: The biology and behavioural basis for smoking-attributable disease: A report of the surgeon general. 2010.
   
4. Centers for Disease Control and Prevention (US). Reports of the Surgeon General. In: The Health Consequences of Smoking: A Report of the Surgeon General. 2004.
   
5. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97.