Article: 19840701080


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539 SMOKING AND CARDIOVASCULAR DISEASE The U.S. Department of Health and Human Services' (DHHS) 1983 report on the health consequences of smoking reviews the evidence associating smoking with coronary heart disease (CHD) and other forms of cardiovascular disease (CVD).




539 SMOKING AND CARDIOVASCULAR DISEASE The U.S. Department of Health and Human Services' (DHHS) 1983 report on the health consequences of smoking reviews the evidence associating smoking with coronary heart disease (CHD) and other forms of cardiovascular disease (CVD). It concludes that cigarette smoking is a major cause of CHD for both men and women and should be considered the most important of the known modifiable risk factors for CHD.

The report estimates that up to 30% of deaths from CHD can be attributed to cigarette smoking; approximately the same percentage of cancer deaths have been attributed to smoking. However, because there are more CHD deaths in the United States than cancer deaths (565,000, compared with 416,000 in 1980), estimates of cigarette smoking-related CHD deaths (170,000) are higher than estimates of cigarette smokingrelated cancer deaths (125,000).

Atherosclerosis, the main underlying process of CVD, is characterized by the accumulation of lipid in the intima of large elastic arteries (aorta) and medium-sized muscular arteries (coronary, femoral, carotid, and others). Autopsy studies have demonstrated a significant positive relationship between smoking and atherosclerosis. The evidence is most striking for atherosclerosis of the aorta, but a significant positive relationship exists with lesions of the coronary arteries. Coronary Heart Disease

Prospective mortality studies involving over 20 million person years of observation reveal that smokers have a 70% greater CHD death rate than nonsmokers. Heavy smokers (those who smoke two or more packs per day) have an almost 200% greater CHD mortality rate than nonsmokers.

Cigarette smoking increases the risk of developing CHD, and this effect is independent of the other major risk factors for CHD. However, smoking interacts with the other major risk factors (elevated serum cholesterol and hypertension) to substantially increase the CHD risk beyond the sum of the independent components. Each factor contributes about the same order of magnitude of risk for CHD. When one factor is present, the risk approximately doubles; with two factors, the risk is fourfold greater; and when all three are present, the CHD risk is eightfold greater than when none of the three factors are present.

Cigarette smokers experience a twofold to fourfold greater risk for sudden cardiac

death than do nonsmokers. This risk is dose-related when measured by the number of cigarettes smoked per day.

A synergistic relationship between oral contraceptive use and cigarette smoking exists for myocardial infarction. Women who use both have a 10-times higher risk than women who use neither.

A substantial benefit of smoking cessation in reducing the risk of CHD can be detected within a few years of cessation. Ten years after cessation, the CHD risk of an exsmoker approaches that of a person who has never smoked.

Cerebrovascular Disease

An association between smoking and cerebrovascular disease has been found in numerous prospective mortality studies. This relationship is stronger in younger age groups. The increased risk of cerebrovascular disease from smoking appears to decrease rapidly after cessation.

The combination of smoking and oral contraceptives is associated with marked increase of risk in women for one particular type of cerebrovascular disease—subarachnoid hemorrhage.

Other Forms of Vascular Disease

Smoking is the major modifiable risk factor for atherosclerotic peripheral vascular disease. Smoking cessation is important in the clinical management of patients with peripheral vascular disease, as it is with other forms of CVD. Mortality due to rupture of abdominal aortic aneurysms is more common among smokers than among nonsmokers.

Intervention Studies

The 1983 DHHS report notes that one of the elements supporting the judgment of causality in the smoking-CHD relationship is the effect of smoking cessation: smokers reduce their excess risks when they stop smoking. The report describes numerous intervention programs and trials in this country and abroad, concluding that the effectiveness of the interventions increases when multiple methods such as individual counseling, group sessions, and media cam: paigns are appropriately combined with proper reinforcement and follow-up.

Morbidity & Mortality Weekly Report, Jan. 6, 1984



The Food and Drug Administration (FDA)

has declared that fructose or any other substance that its makers claim will "minimize or prevent inebriation" will be considered a new drug.

As such, it must be reviewed and approved by the FDA before it may be marketed over the counter, Margaret Heckler, Secretary of Health and Human Services, said in a recent Federal Register notice.

"The agency is concerned that such products may present a potential health hazard, particularly when motorists rely on unsubstantiated claims that the products will prevent or minimize an inebriated state," the FDA said.

"Products that claim to prevent or minimize inebriation could give persons who consume alcoholic beverages and then drive a motor vehicle a false sense of security, convincing them that they are capable of driving when, in fact, they are not," the FDA notice said.

Status Report,

Sept. 20, 1983

LIFE ENHANCING OR DESTRUCTIVE : O^TX BEING 'HIGH' CAN BE BOTH Hamilton—Describing someone as 'high' names a category of activity, but the experience can be life-enhancing, self-destructive, or anything in-between, says Calgary educator Ken Low.

"An intoxicant is a tool for getting high, but so is (Toronto's) CN Tower," he told the annual Institute on Addiction Studies here.

People like to get high because things look different, and they want things to look different because "the human mind can stand anything but boredom."

A person 'high' on the CN Tower could make a nuisance of himself with irresponsible behavior such as dropping things over the edge. He could experience mirth from the sudden change of perspective, when the cars below look like toys.

He might have an esthetic reaction from looking at the scenery, or he might begin asking questions and analyzing to get a better understanding of the lay of the land.

He might "freak out" at how high he is, and drop to the floor, screaming, or experience fear or minor discomfort. Realizing he's only six inches from infinity, he might go over the edge.

Betty Lou Lee, Journal of the Addiction Research Institute, Toronto, Sept. 1, 1982

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