Smoking and Cardiovascular Diseases - Term Paper Example

 Smoking and Cardiovascular Diseases Introduction Majority of people associate cigarette smoking and tobacco with lung cancer and breathing problems. However, in addition to these, smoking is a major cause of cardiovascular disease that is, blood vessel and heart diseases. Tobacco and cigarette smoking have been regarded as major risk factors for different chronic diseases Everett (2004). According to AHA (American Heart Association) cigarette smoking is seen as the most significant and preventable reason for many premature deaths McCay et al. (2009). Smoking has been highly associated with the occurrence of cardiovascular diseases. Rhonda’s family presents evidence of cardiovascular diseases. Her prolonged smoking worsened her situation, and therefore there must be a relationship between smoking and these illnesses. This paper assess the link that exists between the two( smoking and the occurrence of cardio vascular diseases) with reference to the current research findings, and in relation to the case study that presents Rhonda as being a previous heavy smoker for over fifteen years, and who has been suffering from hypertension for nine years now. Brief history on Smoking and cardiovascular diseases In the 1960s, some research scientists discovered that smoking causes blood vessel diseases, either inside or outside the heart Wilhelmsen (1991). Other researches have been conducted since this period, most of them showing that there exists a strong relationship between cardiovascular diseases and smoking Haustein (2009). Most of the people, who suffer from high blood pressure, diabetes, obesity, or exhibit high levels of cholesterol, are exposed to the risk of contracting cardiovascular disorders. Rhonda has had hypertension (high blood pressure) for nine years, and she in fact took medication for this and for her high cholesterol. Additionally, she has had mild depressions, which she keeps in check with intermittent psychotherapy sessions. The combination of all these risk factors for cardiovascular disease, in addition to smoking, must have placed Rhonda at an even greater risk. Link between Smoking and cardiovascular diseases The likelihood of developing a cardiovascular disease increases with ones lifetime exposure to smoking Wang (2006). In this case, the numbers of cigarettes that are smoked each day are of major concern. Rhonda’s habit of smoking about a pack of cigarettes per day, for about fifteen years is shocking. According to the National Research Council of the United States (1986) a large number of epidemiological, laboratory and clinical studies in a variety of settings and among diverse population groups have provided very consistent evidence of the primary role of tobacco smoking in the genesis of atherosclerotic events and acute cardiovascular diseases. In the following section, a review of the current pathophysiological and epidemiological evidence, linking smoking and cardiovascular disease has been given. Epidemiology and smoking Smoking has been discovered to have a great impact on acute, thrombotic events as unlike on atherogenesis Labarthe (2010). This is mostly manifest in young and middle aged adults, where smoking is responsible for about 50% of premature severe myocardial infarctions. The relative danger of cardiovascular events is greater in younger smokers, because they are extremely unusual in young nonsmokers. In “the interheart study”, (case control study carried out in more than 50 countries) Teo et al. compared over ten thousand cases of myocardial infarctions with over fourteen thousand age and sex matched controls. It was found out that the effect of present smoking was considerably greater in younger participants, and was particularly marked in younger participants, who smoked twenty cigarettes, or more daily. However, it was discovered that the total mortality caused by smoking rises gradually with age. Among the persons with severe myocardial infarctions, smokers have a shorter life span, a phenomenon termed as the “The smoker's paradox” .Although this exclusive combination of a larger propensity to severe thrombosis with fewer extensive atherosclerosis may present a survival advantage over non-smokers, smokers have even a worse outcome than non-smokers in some other less severe coronary settings, for instance, after a bypass surgery. Tobacco smoking interacts in a multiplicative way with the main cardiovascular risk factors. Whenever smoking is present with another risk factor, a higher risk usually results. For instance, a recent analysis of forty one cohort studies, concerning over five hundred thousand people established that smoking considerably exacerbated the contribution of systolic hypertension to the risk of stroke (hemorrhagic stroke). Rhonda’s evaluation data on admission indicates that she had a pulse rate of 72 beats per minute, and a blood pressure of 138/91 mmHg. Given that the normal blood pressure is averaged at around 120/80 mmHg, then this is a very high pressure for Rhonda. The risk of contracting cardiovascular disease increases with the number of cigarettes smoked every day, although the relationship is not so straightforward. Firstly, the measure of the exposure that has widely been used in studies (cigarettes smoked per day) is of questionable validity. Smokers might smoke fewer cigarettes per day, yet may inhale more deeply, thereby maintaining their plasma- nicotine level, and therefore increasing their exposure to dangerous tobacco smoke toxin. Secondly, the nature of tobacco product used is of importance. Specifically, low tar and low nicotine cigarettes are smoked in a different way from the ordinary cigarettes and, while cigar smoke contain the same toxins that are found in cigarette smoke, cigar smokers mostly tend not to inhale. Thirdly, the link between smoking and cardiovascular risk is usually nonlinear. Smoking at too low levels of exposure, such as one to four cigarettes per day, confers almost three-fold higher danger of dying of coronary heart disease, as compared to not smoking Weidner (2002). Starting from five and above cigarettes smoking per day, the gradient of the exposure risk curve becomes considerably less steep. Link between smoking and atherosclerosis Smoking is one of the main causes of atherosclerosis. Atherosclerosis is a build-up of fatty substance in the arteries. Atherosclerosis occurs once the lining of the arteries deteriorate. This occurs when the walls of the arteries thicken, and deposits of fat block the blood flow through the arteries. In case of coronary artery diseases, the arteries which supply blood to the heart become narrowed, thereby reducing the supply of blood rich in oxygen to the heart. During increased activity, the extra strain on the heart can result in chest pain (angina pectoris) among other symptoms. In case of peripheral artery infection, atherosclerosis affects the arteries which carry blood to the limbs that is arms and legs. As a result, the patient is very much likely to experience a painful cramping of leg muscles when walking. This condition is known as intermittent claudication. Peripheral artery infection has also been noted to increase the risk of stroke. The case study on Rhonda clearly shows that she has had hypertension for about nine years, for which she took medication besides that for her high cholesterol levels. Furthermore, she has had mild depressions, which she also kept in check with intermittent psychotherapy sessions. Research shows that there were approximately 355,600 Australians who were suffering from coronary heart diseases in the year 2001. In addition, statistics show that coronary heart diseases are the major cause of deaths in Australia. Also sudden deaths mostly result from this disease. For example, in the year 2004 there were twenty four thousand, five hundred and seventy six deaths in Australia, all of which resulted from coronary heart disease. This accounted for 18.5% of all deaths in Australia. Those who are already suffering from a heart disease are strongly advised to stop smoking, mainly because this is the most important thing that can be done to reduce their risk of more coronary heart diseases. Link between smoking and heart attack The risk of heart attack to any person significantly increases with the number of cigarettes that he or she smokes. Actually, there is no safe amount of smoking. Smokers only continue to increase their risk of heart attack, as they smoke for longer periods. In fact, people who smoke one pack of cigarettes each day have more than twice the risk of heart attack than non-smokers. Heart attacks are usually fatal and out of every ten Australians, four die within one year of contracting a heart attack. Link between smoking and Blood rheology Smokers have recently been shown to have reversible increase in blood viscosity (thickness) when compared to non-smokers. This is as a result of increase in haematocrit and plasma viscosity. Increase in the plasma viscosity is due to elevated levels of plasma fibrinogen, in addition to other “acute phase reactants” proteins, like alpha2 macroglobulin. In a recent study, a number of groups consisting of males who had donated blood were investigated. The first group was composed of those who had never smoked; the second group were ex-smokers, the third group smoked between ten and twenty cigarettes daily, the fourth group smoked between twenty one and forty cigarettes, while the fifth group smoked more than forty. Haematocrit, plasma white cell count, blood viscosity, blood cell filterability and aggregation, plasma colloid oncotic pressure as well as fibrinogen were measured. Results show that smoking is associated with a progressive significant deterioration of the above haemorheologic variables. These changes are interpreted as an absolute and a relative polycythaemia possibly in conjunction with a chronic inflammatory process. It is concluded that smoking induces a dose-related increase in viscosity of blood among young men which is reversible by abstention. Further, in a recently conducted case control study, the danger/ risk of intermittent claudication for a particular rise in plasma viscosity was only marginally reduced after adjustment for life-time smoking. Conclusion In this paper, the link between tobacco (smoking) and blood vessel and heart diseases (cardiovascular diseases) has been discussed. Various studies have been used to provide evidence on the findings about this relationship. Specifically, the relationship between smoking and cardiovascular diseases was initially elucidated in epidemiological studies, which included the “British Doctors Study” and “Framingham Heart Study” among others. Further studies have reviewed pathophysiological and epidemiological evidence that shows the link between smoking and cardiovascular diseases. More over, smoking has been proven to be one of the main causes of atherosclerosis, heart attack, and blood rheology among others. Rhonda’s case has been of great help in understanding and developing an insight in all the above. References Everett C. (2004) Health Consequences of Smoking Cardiovascular Disease: Report Of the Surgeon General, New York: DIANE Publishing. Groneberg D. and Haustein, K. (2009) Tobacco or Health? Physiological and Social Damages Caused by Tobacco Smoking, New York: Springer. Labarthe, D. (2010) Epidemiology and Prevention of Cardiovascular Diseases: A Global Challenge, Sudbury: Jones & Bartlett Learning. McCay, W. et al. (2009) The Truth about Smoking, NewYork: Infobase Publishing. National Research Council (U.S.). (1986) Environmental tobacco smoke: measuring exposures and assessing health effects, Cambridge: National Academies. Wang, Q. (2006) Cardiovascular disease: methods and protocols, New Jersey: Humana Press. Weidner G. (2002) Heart disease: environment, stress, and gender, Amsterdam: IOS Press. Wilhelmsen L. (1991) Smoking as a cardiovascular risk factor: new strategies for smoking cessation. Kirkland: Hogrefe & Huber.     Read More