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All forms of smoking are bad for the heart

Electronic cigarettes, shisha, cigars, cigarettes and passive smoking should be avoided

All forms of smoking are bad for the heart, the European Society of Cardiology (ESC) warned today ahead of World No Tobacco Day on 31 May.

Health Policy & Healthcare Settings
Risk Factors, Epidemiology, Rehabilitation and Sports Cardiology


Sophia Antipolis, 31 May 2015: All forms of smoking are bad for the heart, the European Society of Cardiology (ESC) warned today ahead of World No Tobacco Day on 31 May.

 “Smoking of all types is still, without any competition, the strongest risk factor for cardiovascular disease. It beats everything. There has been a lot of research over the past 2-3 years which makes us very clear that all tobacco use, including the waterpipe, smokeless tobacco and electronic cigarettes, is simply not good for your health.”1

said ESC prevention spokesperson Professor Joep Perk.

Studies suggest that waterpipe smoking, also referred to as shisha and hookah, may be associated with even greater toxin exposure because sessions are longer and involve more and larger “puffs”, leading to smoke inhalation as much as 100 times more than from a cigarette.2

“Electronic cigarettes may be moderately effective in helping smokers quit but they need the same marketing restrictions as cigarettes to avoid uptake by young people and non-smokers,” said Prof Perk.

The ESC advocates that electronic cigarettes should be regulated as a tobacco and medical product in the European Commission’s Tobacco Products Directive.3 Scientific evidence shows that even cartridges labelled as containing “no nicotine” may contain nicotine and other toxic substances and that flavours such as vanilla or chocolate attract children.

Tobacco use among adolescents is increasing, and in some countries (e.g. Czech Republic, Latvia, Lithuania), tobacco use among youth is very similar to that among adults.4

Prof Perk highlighted the importance of stopping teenagers from beginning to smoke. He said: “I would compare it with a fire in a hay barn. In the beginning it smokes a little but in the end the whole thing goes up in flames. If you start smoking in your teens you won’t suffer immediately but you start a process of vascular damage5 that you will have to pay for later in life. It’s the worst thing you can do to your health.”

He added: “The job of parents as role models and educators has not been underlined strongly enough. Parents are responsible for their kids and can’t give up on them when they become teenagers. A 12 year old who starts smoking also begins the process of atherosclerotic disease with inflammation in the vascular wall. Parents need to be very strict and not allow smoking because we know it is so damaging to health.”

Prof Perk continued: “The tobacco industry knows how to infiltrate youth activities by promoting cigarettes during rave parties and discos. This is unacceptable and we need stricter controls. Legislative measures on packaging, no sale of tobacco products to under-18s and forbidding smoking in public places including school yards is essential.”

The ESC advocated for the protection of young people in the Tobacco Products Directive through banning flavours, avoiding trademarks or promotions and instead introducing plain packaging, displaying health warnings on 75% of the back and front surfaces of packages, having age verification systems for retailers with large economic penalties for those who fail to comply, and requiring medicine authorisation for all non-tobacco nicotine containing products.3

Passive smoking is also deadly. A non-smoker living with a smoking spouse has an estimated 30% higher risk of cardiovascular disease and exposure in the work place poses similar risks.1

Prof Perk said:

“There are so many studies now confirming that passive smoking carries a significant risk for cardiovascular disease. This includes secondary smoke from all sources including the waterpipe.”6

He concluded:

“Smoking of all types is the number one villain in the battlefield of cardiovascular disease prevention. Smoking is two times more significant for heart attacks on a population level than nutritional habits, physical activity and other risk factors. Countries that want to get rid of heart attacks should get rid of smoking before even thinking about anything else.”

ENDS

References

1European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal. 2012;33:1635–1701. doi:10.1093/eurheartj/ehs092
2Al Suwaidi J, Zubaid M, El-Menyar AA, et al. Prevalence and outcome of cigarette and waterpipe smoking among patients with acute coronary syndrome in six Middle-Eastern countries. European Journal of Preventive Cardiology. 2011;19(1):118–125. DOI: 10.1177/174182671039399
3ESC position paper on the Tobacco Products Directive:
4Current trends and gaps
5Dratva J, Probst-Hensch N, Schmidt Trucksaess A, et al. Adolescent smoking and vascular function in the SAPALDIA youth study. European Heart Journal. 2014; 35 (Abstract Supplement): 901.
6Kumar SR, Davies S, Weitzman M, Sherman S. A review of air quality, biological indicators and health effects of second-hand waterpipe smoke exposure. Tobacco Control. 2015 Mar;24 Suppl 1:i54-i59. doi: 10.1136/tobaccocontrol-2014-052038. Epub 2014 Dec 5.

Notes to editor

The ESC Press Office will be happy to provide spokespeople for comment.

ESC recommendations on smoking:1
•    All smoking is a strong and independent risk factor for cardiovascular disease and has to be avoided.
•    Exposure to passive smoking increases risk of cardiovascular disease and has to be avoided.
•    Young people have to be encouraged not to take up smoking.
•    All smokers should be given advice to quit and be offered assistance.

About World No Tobacco Day
World No Tobacco Day was created by the Member States of the World Health Organization in 1987 to draw global attention to the tobacco epidemic and the preventable death and disease it causes. It is held every year on 31 May.

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean.  Its mission is to reduce the burden of cardiovascular disease in Europe.

 

Facts about smoking

Global impact of smoking
•    Approximately one person dies every six seconds due to tobacco.1
•    Tobacco caused 100 million deaths in the 20th century. If current trends continue, it may cause one billion deaths in the 21st century.1
Smoking and cardiovascular disease
•    Smoking is responsible for 50% of all avoidable deaths in smokers, half of these due to cardiovascular disease.2
•    Smoking is associated with increased risk of all types of cardiovascular disease including coronary heart disease and ischaemic stroke.2
•    Smoking doubles the relative risk of myocardial infarction in people over 60 years of age. In smokers under 50 years the relative risk is five-fold higher than in non-smokers.2
•    The overall smoking rate in the EU in 2009 was 29%.3
•    A session of waterpipe smoking , also called shisha and hookah, may lead to smoke inhalation as much as 100 times more than from a cigarette.4

Passive smoking
•    A non-smoker living with a smoking spouse has an estimated 30% higher risk of cardiovascular disease and exposure in the work place poses similar risks.2
•    Nearly 80 000 people in the EU died from passive smoking in 2002, of which more than 32 000 died from coronary heart disease and over 28 000 died from stroke.5
•    In 2004, children accounted for 28% of the deaths attributable to second-hand smoke.1

References
1WHO factsheet
2European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). European Heart Journal. 2012;33:1635–1701. doi:10.1093/eurheartj/ehs092
3European Commission. Special Eurobarometer 332 ‘Tobacco’ / Wave 72.3 – TNS Opinion & Social.  Brussels, Belgium, 2010.
4Al Suwaidi J, Zubaid M, El-Menyar AA, et al. Prevalence and outcome of cigarette and waterpipe smoking among patients with acute coronary syndrome in six Middle-Eastern countries. European Journal of Preventive Cardiology. 2011;19(1):118–125. DOI: 10.1177/174182671039399
5European cardiovascular disease statistics 2012