Smoking and Tobacco

Smoking Increases Risk of Heart Disease

Since 1900, cardiovascular disease (CVD) has been the leading cause of death in the United States. CVD includes high blood pressure, coronary heart disease (heart attack and angina), congestive heart failure, stroke and congenital heart defects, among others. Currently, stroke is the third leading cause. Based on findings of the American Heart Association, cigarette smoking is a major contributor to heart and blood vessel problems among Americans. For young men and women (under age 50), cigarette smoking is the most important risk factor for CVD.

Smoking is such a significant risk factor that the US Surgeon General has named it "the most preventable cause of disease and deaths in the United States." From 1997-2001, approximately 438,000 Americans died each year of smoking-related illnesses. It is estimated that 34.7% of these deaths were cardiovascular-related. Atherosclerosis (buildup of fatty substances in the arteries) is the number one cause of death from smoking.

Cigarette smoking:

Damages nearly every organ of the body. (Surgeon General's 2004 Report)
Makes the heart beat faster and work harder by decreasing the oxygen carried in the blood. Carbon monoxide and other gases replace the oxygen.
Causes coronary heart disease (CHD), which leads to heart attacks. It doubles the chance of having a heart attack.
Damages the coronary arteries, which supply heart muscle tissue with blood and nutrients.
Damages the flow of blood needed by men to have an erection. Smoking and diabetes are the leading cause of impotency (inability to have an erection).
Harms the aorta, the large blood vessel that moves blood from the heart to all parts of the body except the lungs.
Decreases HDL (good) cholesterol.
Increases the risk of CHD for women who use oral contraceptives.
Works with other risk factors like lack of exercise and high blood pressure that increase the chance of heart disease. It raises blood pressure, decreases exercise tolerance, and increases blood clot formation.
Is the biggest risk factor for sudden cardiac death: Smokers have two to four times the risk of nonsmokers.
Is an important cause of brain attack/stroke, increasing the risk for an aortic aneurysm. The relative risk (RR) of stroke in heavy smokers (>40 cigarettes a day) is twice that of light smokers (<10 cigarettes per day.)

Smoking cigars and pipes increases the risk of death from CHD and possibly stroke, but not as much as cigarette smoking. Pipe and cigar smokers may be less likely to inhale the smoke.

Secondhand smoke, which is smoke coming from another person, increases the risk of heart and blood vessel disease. It is responsible for a large number of of smoking-related deaths. The American Heart Association estimates that more than 38,000 people die from heart disease caused by other people's smoke each year. Of these, about 35,000 nonsmokers die from CHD, which includes heart attack. This happens when people are exposed for long periods of time to secondhand smoke in homes or workplaces.

African American Smokers and Heart Disease Risk

In 2005, 21.5 percent of African Americans smoked, compared to 21.9 percent of whites (CDC, 2006). Although smoking rates have been declining since 1965, African American males have higher rates for smoking (26.7%) than African American females (17.3%).

More that 45,000 African Americans die from smoking-related diseases each year. While African Americans smoke fewer cigarettes per day than whites, on average, they tend to smoke brands with higher nicotine levels. In addition, three of every four African American smokers prefer menthol cigarettes. Menthol may facilitate absorption of harmful cigarette smoke constituents.

Impact of Menthol Cigarettes

If the current patterns continue, an estimated 1.6 million African Americans who are now under the age of 18 will become regular smokers. About 500,000 of those smokers will die of a smoking-related disease. Non-smoking African Americans also have a higher rate of exposure to environmental tobacco smoke than whites, which will contribute additional deaths due to cardiovascular disease.

Although African Americans have lower overall exposure to tobacco smoke, they are more susceptible to developing smoking-related diseases. Compared to their white counterparts, African Americans have heart and blood vessel disease at much higher rates:

Around 40 percent of African American men and women have some form of heart disease, compared to 30 percent of white men and 24 percent of white women. (Office of Minority Health)
The death rate from heart and blood vessel disease among African Americans is higher: 33.6 percent higher among African American men and 38.5 percent higher among African American women. (U.S. 2003: American Heart Association)
African Americans have almost twice the risk of first-ever stroke.
African Americans are twice as likely to die from stroke, according to the National Stroke Association. The death rate from stroke among African American men is 51.8 percent higher, while the death rate from stroke among African American women is 36.8 percent higher.

Learn your risk factors and the warning signs of heart disease and stroke at Search Your Heart: Heart Disease, Stroke and African Americans.

You can obtain more information on smoking cessation and African Americans by calling the National Cancer Institute at 1-215-728-2795 and asking for "Pathways to Freedom: Winning the Fight Against Tobacco." You may also access it online at www.smokefree.gov/docs/pathways_final.pdf.

Women Smokers and Heart Disease Risk

Since 1980, when the first Surgeon General's Report on Women and Smoking was released, about 3 million women have died prematurely of smoking-related diseases. On average, women smokers who die of a smoking-related disease lose 14 years of potential life.

More than 20 million American women smoke (18.1%, compared to 23.9% of men.) Although smoking prevalence had been declining during the past eight years, this decrease in smoking rates appears to be stalling.

Smoking is a major cause of heart disease among women:

Cigarette smoking has been associated with sudden cardiac death of all types in women.
Women who smoke have an increased risk for ischemic stroke (blood clot in one of the arteries in the brain) and subarachnoid hemorrhage (bleeding in the area surrounding the brain).
Women who smoke have an increased risk for peripheral vascular atherosclerosis.
Women who smoke and use oral contraceptives (birth control pills) greatly increase their risk of coronary heart disease and stroke compared with nonsmoking women who use oral contraceptives.
Women who started smoking before the age of 15 are more likely to suffer a heart attack or die from heart disease than nonsmokers.
Risk increases with the number of cigarettes smoked and the duration of smoking.
Smoking low-tar or low-nicotine cigarettes rather than regular cigarettes appears to have little effect on reducing the risk for CHD.
Secondhand smoke increases risk of heart disease by 25% in women who do not smoke.

Women who stop smoking greatly reduce their risk of dying prematurely. Most importantly, quitting smoking is beneficial at all ages:

Risk of CHD is cut by one third within 2 years of smoking cessation.
After 10-14 cigarette-free years, heart disease risk is the same as that of a woman who never smoked.
Former smokers have the same stroke risk as nonsmokers after 5 to 15 years.

Since 1984, the number of CVD deaths for females has exceeded those for males. Although heart disease is sometimes thought of as a "man's disease," it is the leading cause of death for both women and men in the United States, and women account for 51% of the total heart disease deaths.

Source: CDC/NCHS. Preliminary underlying mortality for 2003. American Heart Association
Note: Death rates are age-adjusted per 100,000 population, based on the 2000 U.S. standard. Some data are reported according to ICD/9 codes and some use ICD/10 codes.

Nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer.

Heart disease is also often perceived as an "older woman's disease," and it is the leading cause of death among women aged 65 years and older. However, heart disease is the 3rd leading cause of death among women aged 25–44 years and the 2nd leading cause of death among women aged 45–64 years.

African American females carry a disproportionate amount of the burden of heart disease. In 2002, age-adjusted death rates for heart disease were 29.3% higher among black women (169.7 per 100,000) than among white women (131.2 per 100,000).

Lifestyle modifications recommended for all women to help reduce their risk for heart disease include:

Cigarette smoking cessation
30 minutes physical activity most days
Heart-healthy diet
Weight maintenance/reduction
Evaluation and treatment of depression

For more information on women and heart disease:

Go Red for Women Campaign
The Heart Truth: A National Awareness Campaign for Women about Heart Disease
The Healthy Heart Handbook for Women—2005 Edition (PDF 679K)

Adolescent Smokers and Heart Disease Risk

According to CDC estimates, more than 6.4 million children living today will die prematurely from a smoking-related disease because of a decision they will make as adolescents - the decision to smoke cigarettes.

Tobacco use is a deadly habit that starts early. The younger people are when they begin smoking cigarettes, the more likely they will become strongly addicted to nicotine. Approximately 80 percent of adult smokers started smoking before the age of 18. Although smoking rates among high school students have declined in recent years, 23 percent report current use and 54 percent say they have ever tried cigarette smoking.

African American adolescents are less likely to smoke cigarettes than white adolescents of the same age (6.5% compared to 14.9% of whites). Although there are no significant differences between male and female African American youth, white female adolescents have a greater prevalence of cigarette smoking (16.0%) than white male adolescents (13.4%).

Children and teenagers constitute the majority of all new smokers. Early signs of heart disease and stroke can be found in adolescents who smoke. Additionally, more than 6 million young people are exposed to secondhand smoke daily; more than 10 million youth ages 12-18 live in a household with at least one smoker.

Visit the CDC Foundation to find out what you can do at home and in your community to help adolescents say no to tobacco.

Looking at Coronary Heart Disease Graphically

The following maps of the United States are color-coded to show the heart disease death rates for US counties. The number of deaths is per 100,000 people in each county.

Smoking Map
Heart Disease Death Rates for Whites

Note: Death rates are age adjusted to the 2000 U.S. standard population. SOURCE: National Vital Statistics System, U.S.Census Bureau. May 2004

Heart Disease rates

Heart Disease Death Rates for Blacks

Note: Death rates are age adjusted to the 2000 U.S. standard population. SOURCE: National Vital Statistics System, U.S.Census Bureau. May 2004

You may find specific information for your state by visiting the CDC's Heart Disease and Stroke Interactive State Maps.

The following graph shows the decrease in coronary heart disease and stroke deaths from 1980-2000. The Healthy People 2010 goal is to have fewer than 200 coronary heart disease-related deaths per 100,000 people. For stroke, the goal is fewer than 50 deaths per 100,000 people.

Smoking Chart
Note: Death rates are age-adjusted to the 2000 standard population. SOURCE: CDC, NCHS

Compared to the total population, African Americans and white males have a higher relative risk of dying from CHD. You can calculate your risk for heart disease by visiting the following sites:

Your Disease Risk for Heart Disease (Harvard Center for Cancer Prevention)
Your Disease Risk for Stroke (Harvard Center for Cancer Prevention)
Women's Heart Disease Risk Quiz (Women's Heart Foundation)

In 2000, both African Americans and whites remained above the Year 2010 target for reducing coronary heart disease deaths and stroke deaths. Organizations such as the African American Tobacco Coalition (AATC) are taking proactive steps to help lower these rates. Visit our Quitting Tips page for help on how to quit smoking.

Sources:

American Heart Association
Centers for Disease Control
Office of Minority Health. Heart Disease and Stroke Statistics - 2006 Update
Racial/Ethnnic Differences Among Youths in Cigarette Smoking and Susceptibility to Start Smoking -- Unites States, 2002-2004
Steps to Healthier Women
Tobacco Use Among Adults - United States, 2005 (MMWR)

Member of Minority Health Advisory Board who reviewed this document: Hazel Pegues Williams, Director Partners in Education, Cincinnati Youth Collaborative