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Cardiovascular risk of smoking and benefits of smoking cessation

Elizabeth Jackson, MD, MPH
Geoffrey Barnes, MD, MSc
Section Editor
Christopher P Cannon, MD
Deputy Editor
Brian C Downey, MD, FACC


As of 2015, an estimated 20 percent of men and 16 percent of women in the United States smoke [1]. Globally, an estimated 1.3 billion people smoke, the majority of whom reside in developing countries, where smoking rates are estimated to be as high as 50 percent for men. Smoking rates are higher among those with lower education and income levels. The majority of smokers start smoking before the age of 18 years, most commonly around age 14 to 15 years. Approximately 16 percent of students grade 9 through 12 report smoking cigarettes.

The facts regarding the impact of cigarette smoking on the development of cardiovascular disease are well known to both the medical profession and the public [2-6]. In spite of the extensive data and efforts to educate the public, many smokers do not believe that smoking is harmful for them (or for those around them via secondhand smoke exposure). As an example, in one study of 737 active smokers, over 60 percent of did not believe that they were at an increased risk for a myocardial infarction [7]. (See "Overview of the risk equivalents and established risk factors for cardiovascular disease".)

The relationship between smoking and cardiovascular disease, the effects of smoking on the atherosclerosis process, and the beneficial effects of smoking cessation will be reviewed here [3,8]. The therapeutic approach to smoking cessation is presented separately. (See "Overview of smoking cessation management in adults" and "Pharmacotherapy for smoking cessation in adults" and "Behavioral approaches to smoking cessation".)


Cigarette smoking and CVD — With respect to cardiovascular disease (CVD), the following observations have been made regarding a major role for cigarette smoking:

Smoking is an independent major risk factor for total atherosclerotic CVD, coronary heart disease (CHD), cerebrovascular disease, and all-cause mortality, with an apparent dose-dependent relationship [9-11]. (See 'Dose and duration of smoking exposure' below.)


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