0:07
Hello everybody, my name is Isabella Sudano,
I'm a general consultant in the cardiology unit of the University Hospital of Zurich,
and the topic of today is smoking tobacco and cardiovascular disease.
Tobacco is a wonderful plant with a self-defense secret and
the secret is nicotine.
Nicotine acts as a natural pesticide and kills the insects who try to eat the leaves.
What is lethal for these insects is really interesting for our brain.
0:40
When we use nicotine, it has an effect
on our pleasure center by activating the reward center, which is
one of the oldest parts of our brain, leading to the release of dopamine,
and other mediators that are responsible for the effect of nicotine.
When I'm sleepy, I can get awake with nicotine.
When I need more attention or creativity, there is also a positive effect of nicotine.
At least at the beginning, nicotine has positive effects on our brain.
That's the reason why our brain likes nicotine and why nicotine is so addictive.
In Europe we have a prevalence of male smokers around 40%,
female prevalence around 20%.
There are some differences:
There are countries, like Asia, for example, where the prevalence
of female smoking is much more reduced as compared to the European mean.
In Switzerland, we have around 22% of women who
are smokers, and around 30% of the male.
And that's really a pity because a woman who is a smoker lives as
a mean 11 years less than a woman same age who is a nonsmoker.
For the men the difference is 12 years.
Why does tobacco let us lose so many years?
At first, we can say that all cancer, not only lung cancer,
are more often diagnosed in smokers compared to nonsmokers.
All cardiovascular disease such as stroke, myocardial infarction, but
also rectal dysfunction and
vascular dementia are more often in smokers as compared to nonsmokers.
Chronic lung disease, diabetes, the eye is also involved, age-related macular
degeneration is much more often in people using tobacco as compared to nonsmokers.
As well as rheumatoid, arthritis and other diseases that
are due to changes in our immune system and reduced fertility.
2:53
Looking at Switzerland, a man living in Switzerland has a 3
times higher risk of dying as compared to a nonsmoker.
A woman has a 3.5 higher risk factor of coronary artery disease
and the men have a 15% higher
risk factor of lung cancer when he's a smoker.
That means that around 9,000 people are dying every
year in Switzerland because of tobacco use.
Let's see in detail why tobacco and smoking is so dangerous for us:
In every cigarette, in every tobacco product,
we have oxidant chemicals that lead to inflammation, platelet activation and
endothelial dysfunction, leading to reduced myocardial perfusion,
reduced oxygen availability and coronary occlusion.
Altogether, it leads to myocardial ischemia, infarct, and a higher risk of sudden death.
One big player is carbon monoxide that we take in when we
smoke tobacco, which reduces oxygen availability and
worsens the coronary vasoconstriction.
Nicotine may activate the sympathetic nervous system and increase the heart rate,
blood pressure, and myocardial contractility.
Altogether, they increase the risk of myocardial ischemia, infarction and
sudden death.
4:28
There is no product, no tobacco product, which does not lead
to an increase in myocardial infarction and other cardiovascular disease.
Doesn't matter if I use cigarettes with or without filter, cigars,
pipe, chewing tobacco, the combination of chewing and smoking tobacco.
4:50
Water pipe, if I use water pipe regularly,
then I also have an increase in coronary artery disease and
second hand smoking is also dangerous.
As we can see here, the endothelial dysfunction is exactly the same
if I'm an active smoker, or a passive smokers, as compared to nonsmokers.
5:14
There are many tobacco products, light cigarette, snus, electronic cigarette,
or the new hit of not-burn tobacco that are proposed to be lower risk products.
But in reality, there is no tobacco product that could be defined as safe.
You can reduce the risk of lung disease, but
we will increase anyway the risk of general cardiovascular disease or cancer.
5:39
If we stop smoking, stop using tobacco, then we have many benefits.
Taste and smell are back again within one week.
The carbon monoxide will disappear after 8 hours and
with the time the risk of cardiovascular disease or a cancer will decrease.
6:04
How can we help people on the way to smoking cessation?
At first, we identify people who are using tobacco.
Tell them that the best thing for
their health will be to stop smoking or using tobacco.
Then look how much they are addicted, if they're motivated to stop or
not and find a system, find with them a strategy.
And after the smoking cessation, they don't feel alone,
we have to follow up on them.
6:40
Look at smoking cessation and cardiovascular risks:
A never smokers, is assessed as reference.
A former smoker will stop after 8 years of smoking
and has a lower risk of heart failure.
If I was smoking for more than 30 years, then my risk
will be reduced but will not go back to the never smoker level.
If I'm a current smoker, then I have the highest risk.
7:13
We can use drug to help people in the process of smoking cessation and
if we use nicotine replacement therapy we can reduce the possibility of death or
myocardial infarction.
If we use bupropion or varenicline then we don't have an increase
in cardiovascular disease morbidity or mortality.
So, in conclusion all tobacco products
are associated with an increased risk of atherothrombotic disease.
Cessation of smoking or
tobacco product use is also said to reduce cardiovascular risk.
It's important to stop as soon as possible because the time of exposition to
tobacco and the dose, so, how many cigarettes I smoke,
for example, are important factors determining cardiovascular risk.
Smoking cessation is very cost effective.
Prof. Thomas F. LüscherMD, FRCP, FESC, FACC
