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Opinion: Cancer's not the only smoking risk

/ Source: Special to

There are searing images that make indelible and emotional imprints on our brains. The burning twin towers. Jack Ruby and Lee Harvey Oswald. Jack Nicholson’s demonic face in “The Shining.” I experienced one of those images as a medical student, on the first day I stepped into an anatomy laboratory.

Called over to two human bodies being studied, we were told that one lung we were looking at was from a smoker, the other from a non-smoker. The sight reminds vivid years later — the smoker’s lung was the color of the tailpipe exhaust from a car burning oil. The non-smoker evangelists got a convert that day.

On that day and in the years since, I've personally witnessed the effects of smoking on the human lung. And while lung cancer is the disease most often associated with cigarettes, cardiovascular disease from smoking is far more common, more lethal and more avoidable.

Nearly 2,400 Americans die of cardiovascular disease each day — one every 37 seconds, according to the American Heart Association. Heart disease kills as many Americans as cancer, diabetes, lower respiratory disease and accidents combined. While heart disease is caused by many factors, including heredity, high blood pressure, stress, a sedentary lifestyle and elevated cholesterol, perhaps the most important is cigarette smoking. Smoking triples the risk of dying from heart disease among middle-aged men and women. Indeed, smoking cigarettes remains the single most preventable cause of premature deaths in the United States.

It's important to remember, there is no safe amount of smoking. Trying to cut back to "fewer cigarettes" really won't give you better chance at a healthy heart or help you avoid cancer.

Smoking is a major cause of atherosclerosis, a buildup of fat on the inside of the arteries that conduct blood to the heart and the rest of our body. As fatty materials build up, these blood vessels, which carry critical amounts of oxygen, narrow. Much like a clogged pipe decreases water flow in the bathroom, so blockage of the coronary arteries diminishes the flow of blood to the heart muscle. As a result, nature tries to increase the amount of critical oxygen by making the heart pump more quickly (increasing the pulse), but this is relatively ineffective. If the supply of oxygen is reduced, the heart muscle is starved. It can die. This is the event known as a myocardial infarction, or heart attack.

Because other things besides cigarettes adversely impact heart health, health professionals have focused on risk reduction rather than actual prevention. Tremendous public health efforts, along with major events like the “Great American Smokeout” — always the third Thursday of November — have been focused on getting people to stop smoking.

No safe amount of smoking

There is a lot of free advice, including numerous Web sites, that is geared to helping people quit smoking, but typically it involves offer vague, impractical concepts, such as behavior modification or changing the environment. A better alternative comes from medical centers, which have created entire departments geared to lessening, even in a limited way, cigarettes’ contribution to the nation’s leading killer.

Hilary Nierenberg, the director of the cardiovascular risk reduction program at New-York Presbyterian Hospital, heads a program founded on the conviction that the risk of death from heart attack can be reduced, if not prevented, with cigarette smoking cessation:

  • Target a date to — fix it and stick to it.
  • Know your “triggers” and eliminate them. If the smell of coffee in the morning triggers a cigarette need, try a different way to begin the day.
  • Recognize failure is a step along the way to success. The average number of attempts before a person successfully quits is six.
  • Try medication. There are prescription medications that clearly help relapse. Surprisingly, fewer than 10 percent of physicians prescribe this medication

Results are surprisingly prompt. Twenty minutes after you quit smoking, your blood pressure decreases. After 24 hours, your risk of heart attack begins to decrease. If you quit for as long as one year, your risk of heart disease is half that of a current smoker. After five to 15 years, your risk of stroke is decreased, After 15 years, your risk of heart attack is equal to someone who has never smoked.

So, quit now.

More on smoking  |  heart disease

Dr. Edward V. Craig is Attending Surgeon at the Hospital for Special Surgery in New York City and Professor of Clinical Orthopedic Surgery at Cornell Medical School.