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Chapter Summary

This chapter discusses the epidemiology and pathophysiology of tobacco-related cardiovascular disease (CVD), as well as the cardiovascular benefits of and effective strategies for cessation of tobacco use (see Fuster and Hurst’s Central Illustration). Around 20% of annual cardiovascular deaths are attributed to cigarette smoking. The oxidizing chemicals (reactive oxygen and nitrogen species), volatile organic compounds (such as acrolein, acetaldehyde, and formaldehyde), particulates, carbon monoxide, heavy metals, and nicotine found in tobacco smoke are all thought to contribute to CVD. Smoking has been associated with the development of multiple cardiovascular conditions and events, and smoking cessation results in an immediate reduction in the risk of cardiac events, which continues to decline rapidly. Behavioral support and pharmacotherapy are effective strategies for smoking cessation, and combining these strategies produces the best results. Approved pharmacotherapies include nicotine-replacement therapy (available in the form of patches, gum, lozenges, oral inhalers, and nasal sprays), varenicline, and bupropion. The long-term health effects of electronic cigarettes (e-cigarettes) are not well established and clinicians should thus recommend the use of smoking cessation treatments approved by the US Food and Drug Administration (FDA) first.


Tobacco use causes over 8 million annual deaths worldwide through both active tobacco use and secondhand smoke exposure.1 In the United States, over 480,000 deaths per year are attributable to cigarette smoking,2 and approximately one-third of these smoking-attributable deaths are due to cardiovascular disease (CVD),2 the leading cause of death.3 CVD causes approximately 800,000 deaths a year.4 Approximately 160,000 deaths (20% of annual cardiovascular deaths) are attributable to cigarette smoking, which is also responsible for over 113,000 deaths from respiratory diseases and over 163,000 deaths from cancers.5 The life expectancy of a lifelong smoker is reduced by at least 10 years compared to that of a nonsmoker,6 and smokers have double the risk of cardiovascular mortality as never smokers.7 Therefore, treating tobacco use is a critical component of overall preventive care and cardiovascular risk reduction.

Trends in Prevalence of Tobacco Use

Over 1 billion people use tobacco globally, and over 80% of tobacco users live in low- and middle-income countries.8 The majority of smokers worldwide are men. In 2015, the prevalence of daily smoking was 25% among men and 5.4% among women.9

In the United States, cigarette consumption has been declining since the 1960s when over 40% of Americans smoked (Fig. 8–1). The 1964 Surgeon General’s report highlighted the negative health effects associated with cigarette smoking, laying the foundation for several tobacco control policies and increased public awareness of the risks of smoking. These policies came several years after aggressive and deceptive advertising and marketing campaigns by the tobacco industry to increase the popularity of cigarette smoking, as well as ...

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