An Indiscriminate Threat
Tobacco is a legally addictive substance that adversely affects population health globally. According to the World Health Organization (WHO), smoking kills nearly 8 million people yearly, while secondhand smoke causes another 1.2 million deaths annually. The statistics reflect a widespread underestimation of the deadliness of tobacco.
Some believe tobacco negatively affects the lung and respiratory tract only. However, the truth is that it also seriously harms two other vital organs: the heart and coronary arteries.
Dr Paisan Bunsiricomchai, an internist specializing in cardiovascular diseases at the Cardiology Center at MedPark Hospital, shares his views on the adverse health effects of smoking.
“Besides the lung, many studies call attention to the negative effects of smoking on the heart. The acute effects include increased cardiac output, fast heartbeat, and hypertension. More importantly, smoking degenerates the coronary arteries progressively, causing heart disease, heart attack, and eventual death.”
There is no denying that many patients with cardiovascular diseases are smokers or their close contacts. Although some cannot identify smoking as the cause of the disease, studies, and medical knowledge overwhelmingly suggest that it is best to quit smoking.
Tobacco is indiscriminately harmful.
There are thousands of toxic chemicals in tobacco, with dozens causing cancers, making smoking one of the leading risk factors for cardiovascular and respiratory diseases and more than 20 types of cancer. In addition, these diseases are the leading causes of death globally.
“The toxic chemicals in tobacco trigger cardiovascular diseases and raise blood sugar and lipid levels. They also accelerate the buildup of fatty deposits in the wall of the coronary arteries, thickening blood, hastening protein coagulation, and accelerating arterial blockage. These increase cardiac workload, leading to heart abnormalities and fatal heart diseases.”
“Smoking increases the risk of developing lung, oral, esophageal, colorectal, genitourinary, and other cancers.”
Overlooked fact: tobacco directly affects the heart
Heart and coronary arteries are affected by tobacco directly and continually. As stated above, smoking causes atherosclerotic plaques in arteries and excessive workload on the heart; it is a principal risk for heart attack.
“As I mentioned, smoking accelerates blockage of arteries. If the blockage is acute, severe chest pain follows. Blood cannot reach the heart muscle, leading to myocardial infarction, cardiac arrest, or heart attack, which is deadly.”
“Based on my experience, some patients develop chest pain and heart attack after smoking only one cigarette. Arteries quickly narrow down again in a patient with coronary artery disease treated with balloon angioplasty but refusing to quit smoking. It makes the treatment harder.”
Why do people still smoke, despite knowing it is deadly?
Why do people continue to smoke, ignoring the dangers and adverse health effects of toxic chemicals in cigarette smoke despite international campaigns to raise awareness of the harm of smoking? Having cared for numerous patients, Dr. Paisan forwarded an intriguing opinion,
“Because it does not cause harm right away.”
His short and compelling opinion may explain why media coverage of the deadly effects of cigarettes and graphic warning labels on cigarette packs do not deter people from smoking.
“Cigarette smoking does not harm us instantly. Many patients and people know its adverse effects but ignore them because smoking, like other risk factors, does not manifest noticeable detrimental effects instantaneously.”
“Just think of hypertension. It is asymptomatic. The same goes for hyperlipidemia. Oblivious to us, its detrimental effects and heart disease progress relentlessly. Eventually, when the disease is evident, it is too late. Treatment becomes troublesome, complicated, and takes more time.”
As for secondhand smoke exposure, the risk of developing heart disease is nearly the same as in smokers. Studies found that people exposed to secondhand smoke have more heart disease, lung disease, and cancer risk than non-smokers or people not in close contact with smokers; meaning people should avoid direct or indirect smoke inhalation.
E-cigarettes may be more harmful.
A widely held misconception is that e-cigarettes are safe. People used them as a substitute for regular cigarettes unworriedly and carelessly.
“Recent studies show e-cigarettes are as harmful as regular cigarettes despite containing fewer toxic chemicals. People believe e-cigarettes are safe to use despite the nicotine with addiction potential. Moreover, nicotine is not benign, meaning e-cigarettes can cause heart diseases as regular cigarettes.”
“It is concerning that, according to studies, e-cigarettes make it harder to quit smoking. Non-smokers who start with e-cigarettes are prone to take up regular cigarette smoking habits. The best advice is not to start smoking, whether e-cigarettes or a regular one. Once you become addicted, it is difficult to wean.”
How does a cardiologist like Dr Paisan handle the situation and provide help as patients with cardiovascular diseases increase?
From the cardiologist perspective, Dr Paisan explained that screening is one way to facilitate efficient risk assessment, prevention, and treatment planning. At the Cardiology Center of MedPark Hospital, we provide services with sophisticated medical equipment. Our expert physicians utilize the latest technology to provide the best medical attention to our patients.
“The first thing is to assess patient risk factors. We know tobacco is the predominant one. However, we should thoroughly evaluate for other risks, including blood sugar and whether the patient has diabetes, hypertension, or hyperlipidemia. If these conditions exist, the patient is at higher risk for heart disease.”
“Other factors include genetics and older age, leading to degeneration of blood vessels. These risks are difficult to alter because they are uncontrollable.”
The next step is to screen for early cardiovascular diseases by walking on a treadmill according to a protocol for duration, speed, or incline level while monitoring for EKG changes and chest pain or by echocardiogram. If cardiac muscle contracts poorly, it signifies a heart problem. If there is suspicion of coronary heart disease, the doctor will advise a coronary angiography to evaluate for obstructed blood flow in the arteries. If found, the doctor will perform coronary angioplasty to improve blood flow.
“For those with low risk of heart disease but wishes for a thorough risk assessment, non-invasive heart blood vessels examination like coronary CT angiography or coronary artery calcium scan are available. CT angiography identifies diseased vessels precisely and assists in treatment planning. On a coronary artery calcium scan, if there is a high amount of calcified plaque in the arterial wall, there is a corresponding risk of a heart attack. The treatment plan will be more rigorous to prevent the rapid progression of disease and heart attack.”
The Cardiology Center at MedPark Hospital provides comprehensive treatment for every heart disease level of severity, including prescription medicines or specialized procedures, such as balloon angioplasty, stent placement, coronary artery bypass graft, and surgery to replace or repair valvular heart disease.
A sedentary lifestyle causes delayed diagnosis.
In some cases, patients present with advanced coronary heart disease with > 80% narrowing of the arteries when first seen due to delayed diagnosis secondary to low blood flow requirement commensurate with their sedentary lifestyle and lack of physical activity. People with an active lifestyle will recognize their abnormalities sooner because their heart muscles require more oxygen, and their arteries need to dilate to accommodate higher blood flow. If this cannot meet the requirement, myocardial ischemia ensues, leading to chest pain and irregular heart rhythms. Therefore, people with an active lifestyle will be symptomatic before people in the other group.
Heart disease is easy to prevent.
Dr Paisan opines coronary artery disease is easily preventable with a 70 - 80 percent risk reduction. It is best to begin preventive measures before the frank disease is evident and not to be complacent because you are free of symptoms.
“For heart disease, once you are symptomatic, at least 70% atherosclerotic narrowing of the arteries has already occurred and cannot revert to a normal, clean artery. Therefore, you should take charge of your health, have regular checkups, and control your risk factors as best you can, whether it is to quit smoking, maintain a healthy weight, stick to a healthy diet, or exercise to help control blood sugar, cholesterol, and blood pressure levels, the heart disease risk will decrease dramatically.”
Health checkups should be individualized based on personal risk factors. For example, a patient with a family history of heart disease should have a heart checkup starting at age 20-30. If the patient does not have genetic or other risk factors, a checkup can begin at age 30 - 40.
“If you smoke, do not regard it as just about your health; you are subjecting people around you, including your family members, to risk of gradually eroding their health. And if you are already sick, then it is even more so to quit smoking.”
Article by
Dr Paisan Bunsiricomchai
Cardiologist
Doctor profile