Tobacco has been consumed by human beings for thousands of years, but the unequivocal confirmation of the relationship between this consumption and fatal diseases is relatively recent. It was just in the 50s, of last century, when Doll and Hill [1], in his memorable epidemiological study, confirmed that critical public health fact.
The tobacco epidemic is a serious health threatens that affects most of the countries and has unique characteristics.
• The tobacco products are the only consumed products that kill between one third and half of its chronic consumers [2,3]. To date, tobacco kills 5.4 million people by year 4 and is estimated it will increase to 8.3 million by 2030 [4]. Tobacco related deaths exceed those caused by HIV-AIDS, alcohol, accidents, illicit drugs, obesity and violence altogether [4].
• There is no safe consumption level. The INTERHEART study [5], which assessed the importance of the 9 major coronary risk factors and their relationship with Acute Myocardial Infarction (AMI) in 52 countries, showed that just 1 or 2 cigarettes per day increases AMI’s risk by 30%.
• There is no safe tobacco smoke exposure level [6]. Tobacco smoke is one of major global environmental threats 4 and has been defined as a carcinogen type A.
• Tobacco imposes a severe economic harm to the states, that spend more money on treatment of tobacco related diseases and disability than money they receive from the tobacco taxes [3] .
• Tobacco consumption causes a dependency or addiction as, or more, strong than caused by cocaine or heroin, and most of the times it is developed when the consumer is under 18 y.o. 6 Most of smokers want to quit but only one in 10 who tries it fails to do so annually.
In spite of the current information on tobacco damage to health , more than 1000 million people still smoke, worldwide.
WHO has defined smoking as a “chronic relapsing disease "(ICD 10), with features very similar to other chronic diseases such as hypertension and diabetes.
During the 50s, pioneering studies [7] showed a positive relationship between smoking and coronary heart disease. In the following 50 years, a significant amount of prospective studies thoroughly documented the harm caused by smoking on the cardiovascular system but also its rapid recovery after quitting. Figure 1.
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| Figure 1. Positive relationship between smoking and coronary heart disease. (modified from Law and Wald - Pechacek, T. F et al. BMJ 2004;328:980-983 |
Scientific evidence shows that smoking is the most significant cause of preventable cardiovascular disease and mortality, and smoking cessation is the single most significant cardiovascular prevention intervention .
A large review paper showed that smoking cessation reduces CHD mortality by 36%, comparing to those who continue to smoke, regardless of age, sex, or origin [8].
Nowadays, there are effective therapeutic resources, that significantly increase quit rates [9].
Despite the overwhelming scientific evidence, it is amazing how most of the cardiologists have been remiss in addressing and treating this addictive behavior. We have been merely considering smoking as a "bad social habit" and “one more cardiovascular risk factor”. One would be tempted to explore the reasons for such attitude, that is absolutely opposed to our behavior in relation to other chronic conditions , but I think it's time to look ahead and build a new time on that matter.
The Tobacco and the Heart Symposium aims to raise cardiologists, and other health professionals, awareness on the fact that if we really want to lessen the burden of cardiovascular death, diseases and disability, it is time to intervene and set aside the passive attitude we have been holding so far.
The Symposium is part of a branch of actions and initiatives that World Heart Federation (WHF), the InterAmerican Heart Foundation (ICF) and the South American Society of Cardiology (SSC), backed by the Framework Convention Alliance, are developing to inform, sensitize and train cardiovascular health professionals in order to promote a change of attitude and assume, from now on, the responsibility we have in tobacco control and tobacco dependence treatment.
BIBLIOGRAPHY
1. Richard Doll and A. Bradford Hill, Lung Cancer and Other Causes of Death in Relation to Smoking. Br Med J. 1956 November 10,
2 (5001): 1071-10812. Shafey O, Eriksen M, Ross H, Mackay J. The Tobacco Atlas (3rd edition). Atlanta, GA: American Cancer Society,2009.www.cancer.org/docroot/AA/content/AA_2_5_9x_Tobacco_Atlas_3rd_Ed.asp
3. Jha P, Chaloupka Frank J. Curbing the Epidemic. Governments and the economics of tobacco control. Washington, DC: The World Bank, 1999. www.worldbank.org / tobacco / reports.html.
4. WHO Report on the Global Tobacco Epidemic, 2008. The MPOWER Package, Geneva. World Health Organization, 2008. www.who.int / tobacco / mpower / en / index.html.
5. Shafey O, Dolwick S, Guindon GE, editors. Tobacco control country profiles. Atlanta (GA): American Cancer Society, 2003.
6. Nicotine Addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. http://www.rcplondon.ac.uk/pubs/books/nicotine/
7 Richard Doll and Austin Bradford Hill. Mortality in Relation to Smoking: Ten Years' Observations of British Doctors. Br Med J. 1964 June 6, 1 (5396): 1460-1467.
8. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003 Oct 1 290 (13): 1708, author reply 1708-9.
9. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf
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