Smoking single most imp cause of premature heart attacks

New Delhi: Contrary to the prevalent belief, smoking is the most important cause of premature heart attacks, with India having about 4.5 crore patients with ischemic heart disease, doctors warned today on the eve of the `World No Tobacco Day`.

According to the World Health Organisation, tobacco use is one of the biggest public health threats worldwide which kills nearly six million people a year of whom about 600,000 are non-smokers exposed to second-hand smoke.

And the situation in India is very alarming as around 10 lakh deaths are caused by tobacco every year, with the WHO 2012 Global Report on Mortality claiming seven per cent of all deaths for people aged 30 and over in India are attributable to tobacco.

It is widely believed that tobacco use, especially smoking, causes chronic bronchitis and lung cancer, but many may not know that it is actually the most important cause of premature heart attacks.

About 17.3 million people die of cardiovascular diseases and 10 per cent of the deaths are due to tobacco use, says a recent report by the World Heart Federation. "Smoking is a major cause of atherosclerosis, a build-up of fatty substances in the arteries," said Prof Upendra Kaul, Executive Director of Fortis Escorts Heart Institute and Research Centre.

"It occurs when the normal arterial lining of the heart deteriorates, the walls of the arteries thicken and deposits of fat and plaque block the flow of blood through the arteries," he said.

"If the flow of blood isn`t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die."

Prof Kaul stressed that there is no safer form of smoking and all are equally bad. "Every form of tobacco smoke has multiple poisons, including addictive nicotine, carbon monoxide, tar and hydrogen cyanide. Besides, there are 4,000 other chemicals of varying toxicity," he said.

Prof Kaul pointed out, "a person`s risk of heart attack greatly increases with the number of cigarettes he or she smokes. There is no `safe` smoking level. Smokers continue to increase their risk of heart attack the longer they smoke".

According to the latest INTERHEART study, a case-control study conducted in 52 countries, including India, has found that smoking one to nine cigarettes a day increases the risk of heart attack by 1.5 times, while 10 to 19 cigarettes a day ups the risk by 2.8 and over 20 cigarettes increases the risk by 4.7 times.

The risk increases several fold if women smoke and also use oral contraceptives, suggested the study. "It`s not just the smokers, the people around them also pay a heavy price as passive smoking can cause them chronic respiratory conditions, cancer and heart diseases," Prof Kaul explained.

"Thus, the only and best way to get rid of these dangers is to say `No` to smoking," said Dr Kaul.
"But there`s no one way to quit that works for everybody. To quit smoking, you must be ready, emotionally and mentally," he added.

It has been observed that 75 per cent of those who quit, again smoke and the rate of quitting is very high after an individual suffers a heart attack or a stroke. "Isn`t it better not to wait for catastrophe to strike before deciding to quit?" asked Dr Kaul.

Smoking and other forms of tobacco intake also accounted for nearly 1,20,000 cancer deaths in 2010. Of which 42 per cent were men and 18.3 per cent women, according to a recent study published in `The Lancet`. It also found that 20 per cent of cancer deaths in India was due to chewing of tobacco.

According to the Global Adult Tobacco Survey (GATS) 2009- 2010, nearly 241 million or 35 per cent of Indians (47 per cent men and 20.3 per cent women) are currently using some form of tobacco.