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Reviewed by the Faculty of Harvard Medical School


Although obesity is increasing in its harms and is a close second, smoking remains the leading cause of preventable illness and death in the United States; every year approximately 400,000 deaths are attributed to smoking. At least one in three of these deaths is related to cardiovascular disease.

The reason: Tobacco smoke contains about 4,000 substances, many of them known to cause adverse health effects. The dangers of three of them — nicotine, tar and carbon monoxide — are especially important, and many other less well-known pollutants in cigarette smoke contribute to cancer risk.

  • Nicotine is the principal substance that causes addiction to tobacco. It stimulates the release of epinephrine — adrenaline — into the smoker's bloodstream, forcing the heart to work harder (this may be why smokers have raised blood pressure). By constricting blood vessels, including the coronary arteries, nicotine compromises the heart's blood supply.
  • Tar in tobacco produces chronic irritation of the respiratory system and is a major cause of lung cancer.
  • Carbon monoxide (the same gas in car exhaust that's lethal in closed spaces) passes from the lungs into the bloodstream. In the blood, carbon monoxide combines with hemoglobin and reduces the amount of oxygen that can be carried in your red blood cells. It also damages blood-vessel linings, contributing to atherosclerosis. Over time, persistently high levels of carbon monoxide in the blood lead to hardening of the arteries, which increases the risk of a heart attack.
How Smoking Affects The Heart And Blood Vessels

The main cardiovascular risk from smoking is increased atherosclerosis in blood vessels. Important biologic effects have been identified:
  • Smoking increases the tendency of blood to clot inside blood vessels and obstruct blood flow.
  • Components of tobacco smoke, particularly carbon monoxide, can directly damage the internal lining of the blood vessels.

In addition, it is suspected that the inhaled pollution from chronic smoke exposure keeps inflammation active in your bloodstream. High levels of proteins (including C-reactive protein) that are associated with inflammation have been closely linked to heart attack risk.

Inhaling cigarette smoke — even through secondhand smoke — may lead to serious consequences. The nicotine in smoke raises your blood pressure and increases heart rate. Carbon monoxide reduces the amount of oxygen your blood can carry to your heart and the rest of your body. These effects may lead to oxygen hunger for your heart muscle cells (called ischemia) and may cause chest pain (called angina) or a heart attack. Inhaling secondhand smoke leads to an estimated 37,000 to 40,000 deaths from cardiovascular disease each year.

Besides these effects on the heart and its arteries, smoking is the main cause of chronic lung diseases such as chronic bronchitis, emphysema and, of course, lung cancer.

You Can Stop Smoking

If you smoke, it's never too late to get the benefits of stopping. The day after you quit, your heart already starts to recover. Your risk of heart disease will drop dramatically within the first two years after kicking the habit. According to the American Lung Association, a two-pack-a-day smoker is at double the risk of heart disease compared with nonsmokers. However, for people who quit smoking, the amount of heart risk that is added by smoking can be lowered by one-half within a year.

So how do you do it? It is not recommended for you to reduce your habit only by smoking fewer cigarettes, because studies have suggested that smokers who are permitted less frequent cigarettes end up smoking each cigarette more deeply (and to a shorter butt), so total nicotine intake does not decrease. Switching to low-tar, low-nicotine cigarettes has also not been shown to be a helpful strategy: By inhaling more deeply, smokers can get as much nicotine (and tar) out of a low-nicotine cigarette as from a regular one. The only safe choice is to quit completely. And here's how:

Try the write stuff

Write down your most important personal reason to quit. Is it to regain control of your life and health? To set a good example for your children? To protect your family from the dangers of secondhand smoke? Personal motivation is a key predictor of success in quitting smoking, and keeping a personal "record" of that motivation helps many smokers quit. It also helps to write a letter to loved ones stating the reasons why smoking is so important that you choose to die early rather than be with them. This type of letter is an especially powerful motivating tool for some people.

Keep your mind on the future

Most smokers fail at their first attempt to quit, and nearly all smokers experience some degree of nicotine withdrawal. Smokers who are experiencing withdrawal may jump to a conclusion that they won't ever feel right without their cigarettes. Remember that withdrawal symptoms are temporary. If you can tough out a month or more to overcome these symptoms, you will be rewarded. The quitting process should be taken one day at a time to ensure long-term success. Some people pay themselves for each day they go smokeless — just take the money you'd normally spend on cigarettes or cigars and put it in a jar. At the end of each week or month, buy yourself some "reward" item.

Avoid the triggers

To be successful at quitting, you have to avoid or even leave situations that trigger the urge to light up. That includes social gatherings where smoking is permitted, restaurants, and maybe even your morning coffee. In fact, many smoking cessation experts recommend that you cut back on both caffeine and alcohol while you're trying to quit; both are triggers for smoking. If you like to smoke after a meal, go for a walk instead. If you smoke while watching TV, munch on celery. Keep a diary of when you smoke. The diary can help determine your triggers, so you can avoid or modify them.

Get with a program

Deciding to "tough it out" on your own may not work well over the long term. Women in particular seem to benefit from group support while trying to quit. Even if you go it alone, following a regimen from a smoking-cessation program offers you a better chance at success. You can find these programs in your local Yellow Pages, but you also can get information from these national agencies:

  • Agency for Health Care Research and Quality at 800-358-9295 (
  • American Cancer Society at 800-ACS-2345 (
  • American Heart Association at 800-AHA-USA1 (
  • American Lung Association at 800-LUNG-USA (
  • Centers for Disease Control and Prevention (CDC) Office on Smoking and Health at 800-CDC-1311 (
  • National Cancer Institute (NCI) at 800-4-CANCER (
Don't worry about your waistline

Fear of gaining weight is one of the most commonly cited reasons smokers — especially women — give when explaining why they don't want to quit. Weight gain is a realistic concern, but you should keep this concern in perspective. About one in three smokers gain weight when they quit, but 90 percent of them actually lose that weight within a year or two. Meanwhile, two in three either lose weight (usually by starting an exercise program) or stay at the same weight.

Ex-smokers may gain weight for two reasons: Their metabolism slows from the lack of nicotine and they may compensate for the lack of cigarettes by snacking on candy and junk food. But if you need "finger food," choosing low-fat snacks such as carrot sticks and fruit can help. Meanwhile, the American Heart Association has helpful guidelines for avoiding weight gain. To request a free copy, call the American Heart Association at 800-AHA-USA1, or visit their Web site at

Get help with a nicotine-replacement therapy

Using a nicotine patch or gum has been shown to increase your chances of successfully kicking the smoking habit. The success rate for most programs using counseling plus nicotine replacement is about 20 percent but can range up to 40 percent at some of the best university-based smoking-cessation programs. In the absence of counseling, nicotine-replacement therapy doubles the normal cold-turkey success rate (which is about 5 percent) to 10 percent.

The patches now available over-the-counter are placed on your shoulder or back each morning and worn for about eight weeks; most smokers start with full-strength patches containing 15 to 22 milligrams (mg) of nicotine and then switch to "weaker" patches containing 5 to 14 mg of nicotine. Some people develop slight skin irritations at the patch site, but this is usually easily treated, and moving the patch to another part of the body usually helps.

Nicotine gums, also available over-the-counter, must be chewed slowly for about 30 minutes for best results; usually one piece is chewed every hour or two for up to three months. Many smokers start with a 2-milligram dose, but heavy smokers — those who smoke more than one pack a day — may opt for the 4-milligram dose. Also available are nicotine nasal sprays and inhalers, which may give heavy smokers a faster and higher dose of nicotine that more closely simulates smoking. Some people may find these newer methods more effective in decreasing cravings.

Prescription medications

The medication bupropion (Zyban) also has been shown to be effective in helping people to quit smoking. One recent study showed that 30 percent of smokers on this medication were able to quit for at least one year — and this rate was increased to 35 percent in those who used both bupropion and the nicotine patch. In addition, people who take Zyban gain less weight than those who quit with other methods. Bupropion often is prescribed as an antidepressant with the brand-name Wellbutrin, but it works well even in those who are not depressed. One other antidepressant medicine, nortriptyline (Aventyl, Pamelor, or generic nortriptyline), has been shown, in one study, to provide similar benefit for quitters.

Varenicline (Chantix) is the first new anti-smoking drug to be approved by the U.S. Food and Drug Administration in the past 10 years. It acts directly on nicotine receptors in the brain. The drug tricks brain cells to think that some nicotine is present, so it decreases the desire to smoke. Varenicline also helps dampen nicotine withdrawal symptoms.

Varenicline is easy to take and side effects tend to be mild. You start the drug one week before your quit date. Take 0.5 milligram once per day for the first day, then 0.5 milligram two times per day for a few more days. Increase the dose to 1 milligram twice per day. You stay on that dose for 12 weeks. After 3 months, you and your doctor can decide if can stop the varenicline or continue taking it for another 12 weeks (assuming you have quit smoking). Side effects include nausea, headache and problems sleeping. Some people still have significant withdrawal symptoms.

Do alternative methods work?

While proponents of alternative methods of smoking cessation such as acupuncture and hypnosis claim they can help reduce your cravings for nicotine, no studies have shown that they actually help smokers kick the habit. With acupuncture, fine needles are inserted in and around your ear lobes and the acupuncture technician then may tape a small button on your ear lobe which you are advised to press or massage when the urge to smoke overcomes you. Hypnosis for smoking cessation uses a process called suggestion. When you visit a hypnosis specialist, you'll be put under a trance during which the hypnotist will suggest that you do not enjoy smoking, that cigarettes taste bad, or a host of other negative ideas regarding smoking. The hypnosis theory holds that you will remember these suggestions when the urge to smoke overtakes you.

Last updated November 5, 2007