Smoking and Cardiovascular Disease for Health Care Professionals

C igarette smoking substantially increases the risk of cardiovascular disease, including coronary heart disease, stroke, sudden death, peripheral artery disease, and aortic aneurysm.' The overwhelming and consistent evidence supporting a causal role of smoking in cardiovascular disease derives from large numbers of observational analytic studies, both casecontrol and prospective cohort, in the United States, Europe, and Japan that include more than 20 million person-years of follow-up. The public health toll of this habit is enormous. In the United States, smoking causes more than 230,000 deaths from cardiovascular disease each year, compared with more than 140,000 cancer deaths caused by smoking.2 It is the leading avoidable cause of all deaths as well as cancer deaths in the United States, accounting for more than 400,000 of the more than 2 million deaths each year.2 Decreases in United States smoking rates have been encouraging, as is the mounting evidence of the substantial and almost immediate benefits of smoking cessation on the risk of cardiovascular disease. Nevertheless, smoking is responsible for more than one in every five deaths in the United States, accounting for 29% of total deaths from CHD and 17% of all fatalities from stroke. (Reference 2 and National Center for Health Statistics, personal communication, September 1992) Research is increasingly focusing on the health risks of passive smoking, or environmental tobacco smoke. Environmental tobacco smoke causes lung cancer3 as well as respiratory disease in children.4 The possible effects of environmental tobacco smoke on cardiovascular disease are the subject of an American Heart Association special report.5