Smoking and Your Heart

Cigarette smoking causes about 1 in every 5 deaths in the United States each year. It's the main preventable cause of death and illness in the United States.

Smoking harms nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. This article focuses on how smoking affects the heart and blood vessels.

Other Health Topics articles, such as COPD (chronic obstructive pulmonary disease), Bronchitis, and Cough, discuss how smoking affects the lungs.

Overview

Smoking and Your Heart and Blood Vessels

The chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis.

Atherosclerosis is a disease in which a waxy substance called plaque builds up in the arteries. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Coronary heart disease (CHD) occurs if plaque builds up in the coronary (heart) arteries. Over time, CHD can lead to chest pain, heart attack, heart failure, arrhythmias, or even death.

Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.

Smoking also is a major risk factor for peripheral artery disease (P.A.D.). P.A.D. is a condition in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. People who have P.A.D. are at increased risk for heart disease, heart attack, and stroke.

Smoking and Atherosclerosis

The image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral artery disease. Figure B shows a detailed view of a leg artery with atherosclerosis—plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.

Any amount of smoking, even light smoking or occasional smoking, damages the heart and blood vessels. For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.

Secondhand smoke also can harm the heart and blood vessels. Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.

Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. Secondhand smoke can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.

Secondhand smoke also raises children and teens' risk of future CHD because it:

• Lowers HDL cholesterol (sometimes called "good" cholesterol)
• Raises blood pressure
• Damages heart tissues

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.

Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.

However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk for heart disease.

Benefits of Quitting Smoking and Avoiding Secondhand Smoke

One of the best ways to reduce your risk of heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.

Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members who smoke not to do it in the house and car.

Quitting smoking will reduce your risk of developing and dying from heart disease. Over time, quitting also will lower your risk of atherosclerosis and blood clots.

If you smoke and already have heart disease, quitting smoking will reduce your risk of sudden cardiac death, a second heart attack, and death from other chronic diseases.

Researchers have studied communities that have banned smoking at worksites and in public places. The number of heart attacks in these communities dropped quite a bit. Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.

Outlook

Smoking or exposure to secondhand smoke damages the heart and blood vessels in many ways. Smoking also is a major risk factor for developing heart disease or dying from it.

Quitting smoking and avoiding secondhand smoke can help reverse heart and blood vessel damage and reduce heart disease risk.

Quitting smoking is possible, but it can be hard. Millions of people have quit smoking successfully and remained nonsmokers. A variety of strategies, programs, and medicines are available to help you quit smoking.

Not smoking is an important part of a heart-healthy lifestyle. A heart-healthy lifestyle also includes heart-healthy eating, aiming for a healthy weight, managing stress, and physical activity.

The chemicals in tobacco smoke harm your heart and blood vessels in many ways. For example, they:

• Contribute to inflammation, which may trigger plaque buildup in your arteries.
• Damage blood vessel walls, making them stiff and less elastic (stretchy). This damage narrows the blood vessels and contributes to the damage caused by unhealthy cholesterol levels.
• Disturb normal heart rhythms.
• Increase your blood pressure and heart rate, making your heart work harder than normal.
• Lower your HDL (“good”) cholesterol and raise your LDL (“bad”) cholesterol. Smoking also increases your triglyceride level. Triglycerides are a type of fat found in the blood.
• Thicken your blood and make it harder for your blood to carry oxygen.

Smoking and Heart Disease Risk

Smoking is a major risk factor for coronary heart disease, a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

When plaque builds up in the arteries, the condition is called atherosclerosis.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

Over time, smoking contributes to atherosclerosis and increases your risk of having and dying from heart disease, heart failure, or a heart attack.

Compared with nonsmokers, people who smoke are more likely to have heart disease and suffer from a heart attack. The risk of having or dying from a heart attack is even higher among people who smoke and already have heart disease.

For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.

Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.

Smoking and the Risk of Peripheral Artery Disease

Peripheral artery disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Smoking is a major risk factor for P.A.D.

P.A.D. usually affects the arteries that carry blood to your legs. Blocked blood flow in the leg arteries can cause cramping, pain, weakness, and numbness in your hips, thighs, and calf muscles.

Blocked blood flow also can raise your risk of getting an infection in the affected limb. Your body might have a hard time fighting the infection.

If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.

If you have P.A.D., your risk of heart disease and heart attack is higher than the risk for people who don’t have P.A.D.

Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, including gangrene in the leg from decreased blood flow.

Secondhand Smoke Risks

Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that’s breathed out by a person who is smoking.

Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. It can damage the heart and blood vessels of people who don’t smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults’ risk of heart attack and death.

Secondhand smoke also raises the risk of future coronary heart disease in children and teens because it:

• Damages heart tissues
• Lowers HDL cholesterol
• Raises blood pressure

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome and children who have conditions such as asthma.

Cigar and Pipe Smoke Risks

Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.

However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk of heart disease.

One of the best ways to reduce your risk of coronary heart disease is to avoid tobacco smoke. Don’t ever start smoking. If you already smoke, quit. No matter how much or how long you’ve smoked, quitting will benefit you.

Also, try to avoid secondhand smoke. Don’t go to places where smoking is allowed. Ask friends and family members to not smoke in the house and car.

Quitting smoking will benefit your heart and blood vessels. For example:

• Among persons diagnosed with coronary heart disease, quitting smoking greatly reduces the risk of recurrent heart attack and cardiovascular death. In many studies, this reduction in risk has been 50 percent or more.
• Heart disease risk associated with smoking begins to decrease soon after you quit, and for many people it continues to decrease over time.
• Your risk of atherosclerosis and blood clots related to smoking declines over time after you quit smoking.

Quitting smoking can lower your risk of heart disease as much as, or more than, common medicines used to lower heart disease risk, including aspirin, statins, beta blockers, and ACE inhibitors.

Quitting smoking is possible, but it can be hard. Millions of people have successfully quit smoking and remain nonsmokers. Surveys of current adult smokers find that 70 percent say they want to quit.

There are a few ways to quit smoking, including quitting all at once (going "cold turkey") or slowly cutting back your number of cigarettes before quitting completely. Use the method that works best for you. Below are some strategies to help you quit.

Get Ready To Quit

If you want to quit smoking, try to get motivated. Make a list of your reasons for wanting to quit. Write a contract to yourself that outlines your plan for quitting.

If you've tried to quit smoking in the past, think about those attempts. What helped you during that time, and what made it harder?

Know what triggers you to smoke. For example, do you smoke after a meal, while driving, or when you're stressed? Develop a plan to handle each trigger.

Get Support

Set a quit date and let those close to you know about it. Ask your family and friends for support in your effort to quit smoking.

You also can get support from hotlines and Web sites. Examples include
1–800–QUIT–NOW and http://smokefree.gov. These resources can help you set up a plan for quitting smoking.

Get Medicine and Use It Correctly

Talk with your doctor and pharmacist about medicines and over-the-counter products that can help you quit smoking. These medicines and products are helpful for many people.

You can buy nicotine gum, patches, and lozenges from a drug store. Other medicines that can help you quit smoking are available by prescription.

Learn New Skills and Behaviors

Try new activities to replace smoking. For example, instead of smoking after a meal, take a brisk walk in your neighborhood or around your office building. Try to be physically active regularly.

Take up knitting, carpentry, or other hobbies and activities that keep your hands busy. Try to avoid other people who smoke. Ask those you can't avoid to respect your efforts to stop smoking and not smoke around you.

Remove cigarettes, ashtrays, and lighters from your home, office, and car. Don't smoke at all—not even one puff. Also, try to avoid alcohol and caffeine. (People who drink alcohol are more likely to start smoking again after quitting.)

Be Prepared for Withdrawal and Relapse

Be prepared for the challenge of withdrawal. Withdrawal symptoms often lessen after only 1 or 2 weeks of not smoking, and each urge to smoke lasts only a few minutes.

You can take steps to cope with withdrawal symptoms. If you feel like smoking, wait a few minutes for the urge to pass. Remind yourself of the benefits of quitting. Don't get overwhelmed—take tasks one step at a time.

If you relapse (slip and smoke after you've quit), consider what caused the slip. Were you stressed out or unprepared for a situation that you associate with smoking? Make a plan to avoid or handle this situation in the future.

Getting frustrated with your slip will only make it harder to quit in the future. Accept that you slipped, learn from the slip, and recommit to quit smoking.

If you start smoking regularly again, don't get discouraged. Instead, find out what you need to do to get back on track so you can meet your goals. Set a new quit date, and ask your family and friends to help you. Most people who smoke make repeated attempts to quit before doing so successfully.

Many smokers gain weight after they quit, but the average weight gain is 10 pounds or less. You can control weight gain by following a heart-healthy eating plan and being physically active. Remember the bright side—food smells and tastes better if you aren't smoking.

For more information about how to quit smoking, go to the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Also, go to the U.S. Department of Health and Human Services' Smoking & How to Quit Web page and the Centers for Disease Control and Prevention's Smoking and Tobacco Use Web page.