Smoking is one of the most important and most significant causes of heart disease. Contrary to a widely prevalent belief that smoking only leads to chronic bronchitis and in some instances lung cancer it is actually the most important and a preventable cause of pre mature heart attacks. In a study done by the author in Delhi many years ago and published in American Heart Journal (1986) it was present as a risk factor in 76% patients who had experienced a heart attack below the age of 40 years. At present we have approximately 4.5 crore patients with ischemic heart disease in India.
As per Human Development Report, J&K, 2008, in 53 per cent of the households one or more members are smoking. The least smoking districts are Leh, Kargil and Srinagar. The incidence of families having at least one member smoking is highest in Kashmir. Islamabad tops the chart with 73.9 per cent, followed by Kupwara (73.8 per cent), Pulwama (73.6 per cent), Budgam (71.5 per cent), Baramulla (68.2 per cent), Srinagar (53.8 per cent), Doda (49.9 per cent), Kathua (48.8 per cent), Udhampur (48.1 per cent), Rajouri (42.2 per cent), Poonch (37.5 per cent), Jammu (32.3 per cent), Kargil (27.9 per cent) and Leh (20.7 per cent). The incidence is more in rural (56.2 per cent) than urban (46.1 per cent) areas and the trend exhibits a persistent decline with the educational score and the per capita income of the family but showed an increase with the increase in the size of the family. The 55-64 age group tops the chart with 31.9 per cent

 What's the link between smoking and heart disease?

Smoking is a major cause of atherosclerosis — a buildup of fatty substances in the arteries. Atherosclerosis occurs when the normal lining of the arteries deteriorates, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries. In coronary artery disease, the arteries that supply blood to the heart become severely narrowed, decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.
In peripheral artery disease, atherosclerosis affects the arteries that carry blood to the arms and legs. As a result, the patient may experience painful cramping of the leg muscles when walking (a condition called intermittent claudication). Peripheral artery disease also increases the risk of stroke.
 What’s the link between smoking and heart attack?
A person’s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no safe amount of smoking. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than nonsmokers.
In the INTERHEART study it was observed that smoking 1to 9 cigarettes per day increases the risk of heart attacks by 1.5 times, smoking 10 to 19 cigarettes per day increases this risk by 2.8 times and smoking more than 20 cigarettes per day increases this risk by 4.7 times.
The risk increases several folds in women who smoke and also use oral contraceptives.

Are Hukka, Bidi, Pipe and Expensive filter cigarettes safer ; 
All forms of tobacco smoking are equally bad, in fact smoother and more refined forms may be more dangerous since there is a tendency for deeper inhalations and the toxins reach the blood in higher concentration leading to more damage.
Every form of tobacco smoke has multiple poisons, including addictive nicotine, carbon monoxide, “tars” and hydrogen cyanide. There are 4,000 other chemicals of varying toxicity, including 43 known carcinogens.
 What is second hand (Passive) smoking ?
Cigarette smoke does not just affect smokers. When you smoke, the people around you are also at risk for developing health problems, especially children. Environmental tobacco smoke (also called passive smoke or second-hand smoke) affects people who are frequently around smokers. Second-hand smoke can cause chronic respiratory conditions, cancer and heart disease.
People exposed to second hand smoke have 90% excessive risk of getting a heart attack. For this reason smoking is banned in public places and situations where a large number of individuals assemble and breathe the same air.
 The mechanics of smoking leading to lethal heart disease:
 Decreased oxygen to the heart and to other tissues in the body
 Decreased exercise tolerance
 Decreased HDL (good) and increased LDL (bad) cholesterol.
 Increased blood pressure and heart rate
 Damage to cells that line coronary arteries and other blood vessels
 Increased risk of developing peripheral artery disease and stroke
 Increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis and emphysema
 Increased risk of developing diabetes
 Increase tendency for blood clotting
 Increased risk of spasm of the arteries. 

 Tips to quit smoking !
There is no one way to quit that works for everyone. To quit smoking, you must be ready emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. Plan ahead.
Once you have given up smoking adhere to the following suggestions:

• Get rid of all cigarettes.
• Put away all smoking-related objects, such as ashtrays.
• If you live with a smoker, ask that person not to smoke in your presence. Better yet, convince them to quit with you.
• Don’t focus on your cravings. Remember that what you’re feeling is temporary and remind yourself why you want to quit.
• Keep yourself busy! Review your list of activities you can do instead of smoking.
• When you get the urge to smoke, take a deep breath. Hold it for ten seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
• Keep your hands busy. Play with a pencil or straw, or work on a computer.
• Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette break.
• When you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don't allow smoking, such as the movies, museums, shops or libraries.
• Don't substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so you can avoid weight gain.
• Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.
• Remind yourself you are a nonsmoker. Nonsmokers don't smoke.
• Exercise. Exercising has many benefits and will help you relax.

These days a number of medicines have been developed which help persons who want to quit smoking. These drugs are very expensive approximately Rs 10,000 per person for a course and the success rate is not more than 30 – 40%.  There is nothing like a good counseling, desire to quit and a strong will power.
Interestingly the quit rate is very high after an individual suffers a heart attack or a stroke. It is desirable not to wait to have a catastrophe before deciding to quit. It is however never too late to quit smoking. Remember that quitting smoking reduces your risk to that of a non smoker within 3 years.
If you smoke again (called a relapse) do not lose hope. Seventy five percent of those who quit relapse at least once.  Most smokers quit three times before they are successful. If you relapse, don’t give up! Review the reasons why you wanted to become a nonsmoker. Plan ahead and think about what you will do next time you get the urge to smoke. 

(Prof Upendra Kaul is Executive Director and Dean Cardiology, Fortis Escorts Heart Institute and Research Center & Fortis Hospital Vasant Kunj, New Delhi)

Lastupdate on : Mon, 30 May 2011 21:30:00 Makkah time
Lastupdate on : Mon, 30 May 2011 18:30:00 GMT
Lastupdate on : Tue, 31 May 2011 00:00:00 IST