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INTRODUCTION

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This chapter provides an epidemiological overview of cigarette smoking and its impact on health with a focus on cardiovascular diseases. Although smoking-related pathophysiological changes are discussed in all relevant chapters, this chapter aims to provide a synopsis of smoking-related pathological changes in the cardiovascular system. As health care providers striving to improve cardiovascular health, we are uniquely positioned to promote smoking cessation through counseling and clinical support for both primary and secondary prevention. Chapter 31 discusses the clinical management of patients to prevent and mitigate the adverse effects of smoking. The seriousness, resources, and political will to counterbalance the strong interest and position of the smoking industry may be catching up after a lag of almost half a century. There are growing concerns about (1) an increase in the total number of smokers worldwide with population growth despite a reduction in smoking rates, (2) an increasing prevalence of smoking among young adults and in developing countries, and (3) an increasing uptake of electronic cigarettes (e-cigarettes) ahead of research examining its health effects.

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TRENDS IN PREVALENCE OF SMOKING

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Tobacco Control: A Long and Arduous Journey

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Although the Surgeon General’s report in 1957 concluded that cigarette smoking is associated with an increased risk of lung cancer, it was not until publication of the landmark 1964 Surgeon General’s report that the adverse relationship between cigarette smoking and cardiovascular disease was seriously recognized. The Surgeon General’s report concluded that cigarette smoking is strongly associated with myocardial infarction and coronary heart disease deaths, and it laid the foundation for tobacco control.1 Unfortunately, health care providers, professional societies, civic bodies, and governments have also played negative or timid roles, largely attributed to smoking industry’s exploitation of the natural skepticism and probabilistic nature inherent in scientific evidence, serious conflicts of interest, and lack of a strong public will. Smoking has claimed more than 20 million lives with premature deaths in the United States alone since the publication of the 1964 report.

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The annual per capita cigarette consumption in the United States was at its peak in early 1960s, with a prevalence of about 45% in 1965. Through concerted efforts over more than half a century, the cigarette consumption in the United States has declined to half of its peak prevalence rates—to about 18% in 2012.2 Multiple factors, including an improved understanding of the adverse effects of secondhand smoke, and policy measures such as ban of broadcast advertising, increased public awareness, and the increase in taxes on cigarettes have played an important role in this epidemiological transition (Fig. 30–1). Despite years of progress, cigarette smoking still remains the leading cause of preventable cardiovascular morbidity and mortality across the globe.

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FIGURE 30–1.

Annual adult per capita cigarette consumption and major smoking and health events—United States 1990-1998. ad, advertising; WWII, World War II. Reproduced with permission from Centers for Disease Control and ...

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