Smoking has long been recognised as a major health hazard, contributing to various chronic diseases and among the most severe consequences are the long-term effects on heart health. Despite extensive public health campaigns and warnings, smoking remains a significant risk factor for cardiovascular disease (CVD), which encompasses conditions like coronary artery disease, heart failure and stroke.

In an interview with HT Lifestyle, Dr Abhijit Borse, Interventional Cardiologist at Asian Heart Institute in Mumbai, explained the intricate ways in which smoking damages the heart is crucial for both prevention and treatment efforts -

Mechanisms of Damage

• Atherosclerosis: Smoking accelerates the process of atherosclerosis, where plaque builds up in the arteries, narrowing them and restricting blood flow. This can lead to coronary artery disease, the leading cause of heart attacks. The chemicals in cigarette smoke damage the lining of the arteries, making them more susceptible to plaque buildup.
• Blood Clot Formation: Nicotine and other chemicals in cigarettes promote blood clot formation by making the blood stickier and increasing the levels of clotting factors. This raises the risk of blockages in the arteries, which can cause heart attacks and strokes.
• Increased Heart Rate and Blood Pressure: Nicotine causes an immediate increase in heart rate and blood pressure by stimulating the release of adrenaline. Over time, this constant stress on the cardiovascular system can lead to hypertension (high blood pressure), which is a major risk factor for heart disease.
• Reduced Oxygen Supply: Carbon monoxide from cigarette smoke binds with hemoglobin in the blood, reducing its oxygen-carrying capacity. This means that the heart has to work harder to supply the body with the oxygen it needs, leading to an increased risk of heart disease and heart failure.

Long-Term Consequences

1. Coronary Artery Disease (CAD): Smokers are 2-4 times more likely to develop CAD than non-smokers. This condition can lead to chest pain, heart attacks, and sudden cardiac death. The risk is directly proportional to the number of cigarettes smoked and the duration of smoking.
2. Heart Failure: Chronic smoking damages the heart muscle, leading to heart failure. This is a condition where the heart cannot pump blood effectively, resulting in symptoms like shortness of breath, fatigue, and fluid retention. Smoking-induced hypertension and atherosclerosis are key contributors to heart failure.
3. Stroke: Smoking doubles the risk of stroke, primarily due to its role in promoting atherosclerosis and blood clot formation. Strokes can lead to long-term disability or death, depending on the severity and area of the brain affected.
4. Peripheral Artery Disease (PAD): Smoking can also affect the arteries outside the heart, leading to PAD. This condition causes pain and numbness in the limbs and increases the risk of infections and ulcers, which can sometimes necessitate amputation.

Impact on Recovery and Treatment

Dr Abhijit Borse revealed, “For individuals with existing heart conditions, smoking complicates treatment and recovery. Smokers who suffer heart attacks are more likely to have a second attack and have a lower survival rate compared to non-smokers. Furthermore, smoking can reduce the effectiveness of certain heart medications, making it harder to manage heart disease effectively.”

Quitting Smoking: A Path to Better Heart Health

Asserting that the benefits of quitting smoking are significant and almost immediate, Dr Abhijit Borse shared, “Within 20 minutes of the last cigarette, heart rate and blood pressure drop. Within a year, the risk of heart disease is half that of a smoker's. Over time, the risks continue to decrease, though former smokers remain at higher risk compared to those who never smoked. The long-term effects of smoking on heart health are profound and multifaceted, impacting both the structure and function of the cardiovascular system. Public health initiatives must continue to focus on smoking cessation as a critical component of heart disease prevention. By quitting smoking, individuals can markedly reduce their risk of heart disease and improve their overall quality of life.”

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