December Heart Attacks Are the Most Deadly

December Heart Attacks Are the Most Deadly

And It's Important for You to Know Why

Several medical studies now show pretty convincingly that Americans who have heart attacks around the holidays -- specifically, the time between Thanksgiving and New Year's Day -- are more likely to die than people who have heart attacks at other times of the year.

The increase in cardiac mortality during the holidays is not huge - about 5% - but it is statistically

significant, and it has been confirmed now in several large population studies.

Several investigators have tried to figure out why this is the case, and theories abound. They include:

1)The onset of cold weather as winter begins.

2)Reduced hospital staffing during the holidays.

3)Increased depression and emotional stress.

4)Overindulgence of fatty foods and alcohol.

5)Delay in seeking medical attention.

What's the REAL Reason?

Nobody can prove today exactly why heart attack mortality increases during the holidays. But I have taken the liberty of ordering the above list of theoretical potential causes in ascending order of importance, from least likely to most likely.

The first two explanations - the onset of cold weather, and reduced hospital staffing - are unlikely to play a major role. Higher heart attack death rates during the holidays are just as prevalent in the southern, warmer states as they are in northern states. And investigators who have formally assessed the question have not been able to find any drop-off in the speed or the quality of care when a patient is admitted with a heart attack in December, as compared to any other time of year.

Depression, which is prominent during the holidays - especially among older people for whom the holidays can invoke a sense of loss for happier times, or for loved ones who are no longer present - is a known risk factor for heart attacks, and likely explains at least some of the increased risk. The added stress of the holiday season may also contribute to some degree.

Read about stress as a risk factor for heart disease.

Certain types of dietary indiscretions may help to trigger heart attacks. Some evidence indicates that eating a meal extremely high in saturated fats might help to trigger plaque rupture in diseased coronary arteries. Overindulging in salt might create excess cardiac stress in people with hypertension or heart failure. And loading up on alcohol can trigger "holiday heart" - that is, the onset of atrial fibrillation, which, in turn, could trigger a heart attack in someone with critical coronary artery disease.

But common sense suggests that simple denial plays a very large role in explaining why heart attacks are deadlier around the holidays. People who develop chest pain or other symptoms during the holidays are likely to try just wishing the symptoms away, or attributing them to some other cause (overeating, stress, etc.,) since, how can it be a heart attack? It's Christmas!

Such willful ignoring of potentially dangerous cardiac symptoms tends to go on until those symptoms simply can be no longer ignored.

By that time, the heart attack victim arrives in the hospital much later than he/she would have at other times of the year. This delay can be deadly. When you are having a heart attack, time is of the essence. A delay of a few minutes can make the difference between surviving with a healthy heart, surviving with a very damaged heart - or dying.

Any physician who has taken care of patients with heart attacks over the holidays will tell you that at that time of year people tend to try "riding it out," so as not to ruin the season for their family and friends. By the time they seek help, they are a lot sicker than they would have been had they ignored the holiday season, and sought medical help right away. And as it happens, having to attend a funeral during the holidays also tends to be quite disruptive to family and friends.

Just because it's the holidays doesn't mean you can't be having a heart attack. If you have the symptoms, get immediate medical care.

Learn how to survive a heart attack.

Sources:

Kloner RA, Poole WK, Perritt RL. When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220 000 cases. Circulation. 1999; 100: 1630-1634.

Spencer FA, Goldberg RJ, Becker RC, et al. Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol. 1998; 31: 1226-1233.

Phillips DP, Jarvinen JR, Abramson IS, et al. Cardiac mortality is higher around Christmas and New Year's than at any other time: the holidays as a risk factor for death. Circulation. 2004; 110: 3781-3788.

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How Do the Holidays Affect Your Heart?

How Do the Holidays Affect Your Heart?

What May Lead to Increased Cardiac Risk

While the holidays are meant to be filled with the joy of family and friends and good times, for anyone with heart disease—or who is at an increased risk for heart disease—the holidays instead may be a time of special risk.

Several studies have shown that during the winter holidays not only are heart problems more likely to occur but when they do occur they are more likely to be fatal. The months of December and January are especially risky for people with heart disease.

And according to a 2004 study published in Circulation, the three dates people are most likely to die from heart disease are Dec. 25, Dec. 26, and Jan. 1.

Why Are the Holidays Dangerous to Your Heart?

Why the holiday period is a particularly dangerous time for the heart is being debated among experts. But in trying to pinpoint a culprit, the experts have plenty of potential causes to choose from. In fact, the increased cardiac risk associated with the holidays is very likely produced by many different factors working together.

The Holidays and the Risk of Heart Attack

Myocardial infarctions (heart attacks) account for most of the excess heart problems that occur during the holidays.  

Heart attacks are usually caused by a condition called acute coronary syndrome, or ACS. ACS happens when an atherosclerotic plaque in a coronary artery suddenly ruptures, and a blood clot begins to form at the site of the ruptured plaque.

  If the clot completely occludes the artery, a complete heart attack (known as an STEMI) occurs.  If the occlusion is less than complete, then generally the victim suffers either a “partial” heart attack (an NSTEMI), or unstable angina. All episodes of ACS are considered to be medical emergencies, and if treatment is delayed, increased heart damage or death can occur.

Most likely, the reason ACS is more common during the holidays is that the holiday season tends to abound with “triggers” for ACS - that is, with events that can hasten the rupture of a plaque.  Here are some triggers for ACS that tend to be more common during the holidays than at other times.  While this list stresses the risk factors we see especially during the winter holidays, keep in mind that several of these risks may turn up with any holiday, or with any important event in your life:  

exposure to cold weather

exposure to sudden and unusual levels of exertion, such as shoveling snow

exposure to emotional stress, which is very common and is often fairly severe during the holidays

becoming sedentary over the winter months

exposure to illness, especially influenza, which can produce inflammatory changes in the blood vessels

over-indulging in food, alcohol and/or tobacco

exposure to indoor pollution, such as cigarette smoke, or even a poorly-drafted log-burning fireplace

All these factors likely contribute to the excess in heart attacks that occur over the holidays.

The Holidays and Heart Failure

People with heart failure—a condition in which the heart is no longer able to function adequately to meet all of the body’s needs—are also at increased risk during the holiday period. The reasons that heart failure often worsens over the holidays are similar to the reasons that heart attacks are more common. These include exposure to the cold, sudden exertion (especially after slacking off on routine physical activity), exposure to “winter infections” like the flu, and over-indulgence.

Over-indulgence is a special problem if you have heart failure. Going off a low-salt diet is a common reason people need to be hospitalized for heart failure, especially during the holidays, as is having a few more drinks than normal. 

The Holidays and Cardiac Death

Not only are heart problems more frequent during the holidays, but when heart problems occur they are more likely to prove fatal. Nobody is sure of the reason for this, but the most likely cause is human nature.

Having a heart problem is never convenient, but at what time of year would it be less convenient than during the holidays? Not only would having a heart problem disrupt your own enjoyment of the festivities, but it would disrupt the lives of all your loved ones and friends who have worked so hard and traveled so far to make the holidays perfect. It is quite easy, during these times, to ignore the warning symptoms that might allow for early evaluation and rapid treatment. All too often, people suffering a heart attack during the holidays convince themselves they’re just imagining their symptoms, or attribute them to a stomach problem, or otherwise, excuse themselves from having to seek immediate medical help. (Ignoring cardiac symptoms, by the way, especially at holiday time, appears to be more common among women than men.) 

By the time the symptoms can no longer be brushed off, or by the time your loved ones can tell just by looking at you that you’re in trouble, it may be too late to prevent a catastrophe.

Just because it’s the holidays doesn’t mean it can’t be your heart. In fact, as we have just seen, just because it’s the holidays it’s more likely to be your heart.  Always take potential cardiac symptoms seriously—especially at holiday time.

Summary

Heart problems—and death from heart problems—are more likely to occur during the winter holidays than at any other time. You can reduce your odds of becoming a victim of holiday-related cardiac problems by avoiding the triggers that produce them, by being aware of the symptoms of heart disease, and by acting on those symptoms when you think they might be occurring.

Sources:

Kloner RA, Poole WK, Perritt RL. When throughout the year is coronary death most likely to occur? A 12-year population-based analysis of more than 220 000 cases. Circulation. 1999; 100: 1630–34.

Phillips DP, Jarvinen JR, Abramson IS, Et al. Cardiac mortality is higher around Christmas and New Years than at any other time: the holidays as a risk factor for death. Circulation. 2004; 110: 3781-88.

Spencer FA, Goldberg RJ, Becker RC, Gore JM. Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction. J Am Coll Cardiol. 1998 May;31(6):1226-33.

Environmental Protection Agency. Health Effects of Breathing Wood Smoke. 2007.http://www.epa.gov/burnwise/pdfs/woodsmoke_health_effects_jan07.pdf  

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5 Lesser-Known Risk Factors for Heart Attack

5 Lesser-Known Risk Factors for Heart Attack

By Steven Nissen, MD, Cleveland Clinic Expert - Reviewed by a board-certified physician.
Updated February 02, 2017

Many risk factors for heart attack are well known, among them smoking, diabetes, high blood pressure, obesity, and lack of exercise. These tend to be universal,

meaning they can increase the risk for nearly anyone. But there are other risk factors that put certain people at risk—or put people at risk under certain conditions. Let’s talk about these lesser-known risk factors and who is likely to be affected.

1  Extreme Cold

Cold temperatures cause the arteries to constrict which can cause a sudden increase in blood pressure. Combine this with physical exertion, such as shoveling snow, and the strain may be too much for some hearts to take. Every year, shoveling snow sends more than 11,000 people to the hospital—at least seven percent are with heart trouble.

2  Sudden Exertion

About of sudden, a strenuous physical activity can lead to heart attack in people who are not physically fit. It can happen from something as seemingly harmless as a pick-up game of basketball or from lifting and carrying something heavy, such as a shovel full of snow. People who are not used to exercising, or have traditional risk factors for heart disease, are at increased risk.

3  Heavy Meals

A heavy meal can occasionally trigger a heart attack. Researchers think it happens because eating raises levels of the hormone epinephrine which can increase blood pressure and heart rate.

4  Intense Emotions

Studies have shown that intense anger and grief can cause a heart attack. It probably occurs from a sudden increase in heart rate and blood pressure triggered by an element of surprise. Because many of us experience these emotions in our lifetime and live through them, they are probably more likely to negatively impact people who are already at increased risk for heart attack.

There is a condition called Takotsubo cardiomyopathy, which may imitate a heart attack, but is somewhat different. It tends to occur more often in women, at times of intense grief and produces heart attack-like symptoms that cause sudden heart failure. It is thought to be the result of an arterial spasm. With treatment, the heart failure often resolves after the grief subsides. Later testing generally shows no evidence of heart attack.

5  Related Conditions

When you are diagnosed with a serious medical condition that seems unrelated to your heart, the risk of heart attack may not cross your mind. For this reason, the role of certain conditions in raising the risk of heart attack is often unappreciated. Conditions known to increase the risk of heart attack include:

Rheumatoid arthritis, lupus, and any other inflammatory disease which can cause inflammation in the blood vessels

Preeclampsia (raises blood pressure)

Gestational diabetes (greatly increases the risk of heart attack)

Sleep apnea (causes aggressive heart disease that increases the risk of heart attack by 30 percent over five years)

Prior radiation to the chest (primarily for cancer of the left breast which can damage the heart)

Any person with one of these conditions should see a cardiologist in addition to their regular doctor.

Sources
Smeijers L, Mostofsky E, Tofler GH, et al. Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients. J Psychosom Res. 2017;93:19-27.
Schwartz BG, Qualls C, Kloner RA, K. Relation of total and cardiovascular death rates to the climate system, temperature, barometric pressure, and respiratory infection. Am J Cardiol, 2015;116(8):1290-1297.
Smyth A, O’Donnell M, Lamelas P, et al. Physical activity and anger or emotional upset as triggers of acute myocardial infarction: The INTERHEART Study. Circ, 2016;135(15):1059-1067.
http://emedicine.medscape.com/article/1513631-overview
http://www.medscape.com/viewarticle/412231

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The Health Benefits of Cocoa Extract

The Health Benefits of Cocoa Extract

A Sweet Solution for Heart Health?

Antioxidants found in cocoa may help to fight heart disease. As more and more studies reveal the heart-healthy benefits of cocoa extract, a growing number of purportedly good-for-you chocolate products are hitting the market. From cocoa supplements to fortified chocolate

bars, these products claim to lower blood pressure, keep cholesterol in check, and improve overall heart health. Here's a look at some of the research behind the health benefits of cocoa extract.

1) Cardiovascular Disease

Regular consumption of cocoa products containing flavanols (a class of compounds with antioxidant effects) may reduce a risk of heart disease, according to a research review published in 2008. The review's authors found that flavanol-containing products may produce positive changes in blood pressure, as well as improve function in platelets and the endothelium (a layer of cells lining the blood vessels).

Other research shows that regular consumption of cocoa extract may help protect against heart disease by decreasing oxidative stress (a destructive process that occurs when DNA-damaging free radicals overwhelm the body's ability to neutralize them).

A study published in the Journal of the American College of Cardiology involved 16 adults, all of whom had heart disease. Twice a day for 30 days, all study members drank a beverage with a high concentration of cocoa flavanols (a type of powerful antioxidant).

Later in the study, the participants drank a different, low-flavanol beverage twice a day for 30 days.

Study results showed a 47 percent greater improvement in vasodilation (widening of the blood vessels) during the first treatment period, indicating that cocoa flavanols may help repair damaged blood vessels and increase survival among heart disease patients.

2) Cholesterol

The cocoa extract may help raise levels of HDL ("good") cholesterol, suggests a 2007 study of 25 people with either normal cholesterol levels or mildly elevated cholesterol levels. For the study, researchers split participants into two groups: One group consumed 12 grams of sugar daily for 12 weeks, while the other group consumed 12 grams of sugar and 26 grams of cocoa powder daily for the same time period. Study results showed that those in the cocoa group had a significantly greater increase in HDL cholesterol, an effect known to reduce the risk of heart disease.

3) Diabetes

Following a flavanol-rich diet may help reverse blood vessel damage in people with diabetes, a small study published in 2008 shows. After 30 days of consuming flavanol-rich cocoa three times daily, a group of diabetes patients showed greater improvements in vascular function (compared to patients who weren't assigned to treatment with cocoa).

Should You Use Cocoa Extract?

More research needs to be conducted before cocoa extract can be recommended for disease prevention.

While eating dark chocolate in moderation may boost your intake of heart-healthy flavanols, it's important to limit your consumption of chocolate products containing high amounts of fat and sugar.

Previous studies suggest that garlic, fish oil, and hawthorn may also help to lower blood pressure.

If you're considering using supplements containing cocoa extract, make sure to consult your physician before beginning treatment. Self-treating and avoiding or delaying standard care can have serious consequences.

Sources:
Baba S, Osakabe N, Kato Y, Natsume M, Yasuda A, Kido T, Fukuda K, Muto Y, Kondo K. "Continuous intake of polyphenolic compounds containing cocoa powder reduces LDL oxidative susceptibility and has beneficial effects on plasma HDL-cholesterol concentrations in humans." Am J Clin Nutr. 2007 85(3):709-17.
Balzer J, Rassaf T, Heiss C, Kleinbongard P, Lauer T, Marx M, Heussen N, Gross HB, Keen CL, Schroeter H, Kelm M. "Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial." J Am Coll Cardiol. 2008 3;51(22):2141-9.
Erdman JW Jr, Carson L, Kwik-Uribe C, Evans EM, Allen RR. "Effects of cocoa flavanols on risk factors for cardiovascular disease." Asia Pac J Clin Nutr. 2008;17 Suppl 1:284-7.
Heiss C, Jahn S, Taylor M, Real WM, Angeli FS, Wong ML, Amabile N, Prasad M, Rassaf T, Ottaviani JI, Mihardja S, Keen CL, Springer ML, Boyle A, Grossman W, Glantz SA, Schroeter H, Yeghiazarians Y. Improvement of endothelial function with dietary flavanols is associated with mobilization of circulating angiogenic cells in patients with coronary artery disease. J Am Coll Cardiol. 2010 Jul 13;56(3):218-24. doi: 10.1016/j.jacc.2010.03.039.
Mathur S, Devaraj S, Grundy SM, Jialal I. "Cocoa products decrease low-density lipoprotein oxidative susceptibility but do not affect biomarkers of inflammation in humans." J Nutr. 2002 132(12):3663-7.
National Institutes of Health. "Researchers Ask, 'Is Chocolate Good for You?'". October 21, 2005.
Disclaimer: The information contained on this site is intended for educational purposes only and is not a substitute for advice, diagnosis or treatment by a licensed physician. It is not meant to cover all possible precautions, drug interactions, circumstances or adverse effects. You should seek prompt medical care for any health issues and consult your doctor before using alternative medicine or making a change to your regimen.

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Which Chocolate Products Are Heart Healthy?

Which Chocolate Products Are Heart Healthy?

It is common to hear today about the potential medical benefits of chocolate, in particular, that eating chocolate can help prevent cardiovascular disease. But not all chocolate is healthful.

Several studies have strongly suggested that the flavanols present in some chocolate products act as strong antioxidants, and also as stimulators of nitric oxide. As a result, the theory goes, inflammation may be reduced, platelet function can improve, and blood pressure may be reduced.

All these effects may reduce the risk of coronary artery disease, heart attacks, strokes, and even cancer.

Read more about chocolate and the heart.

What Is The Evidence?

Interest in the health benefits of chocolate was spurred a few decades ago by the recognition that Kuna Amerinds living on the San Blas Islands (near Panama), have a very low incidence of heart disease and cancer compared to Kuna living in mainland Panama. The difference? Those on the San Blas Islands consume large amounts of flavanol-rich cacao.

Several other epidemiological studies have supported the potential protective effects of flavanols present in chocolate products. A randomized trial began in 2015 (the Cocoa Supplement and Multivitamin Outcomes Study - COSMOS) will eventually provide much-needed prospective evidence on whether, and how much, cocoa flavanols are beneficial for our health.

What Are The Common Forms Of Chocolate?

There are many varieties of chocolate products, and the flavonol content varies tremendously among them.

If science eventually is able to prove that chocolate-associated flavanols are healthy, we will need to be aware that a lot of the chocolate we consume contains only a tiny amount of the healthy stuff.

Cacao comes from the raw seeds of the Theobroma cacao tree. Cacao is extremely rich in the flavanols catechin and epicatechin - which are the substances thought to confer cardiovascular benefits.

Cacao is the stuff consumed by the Kuna Amerinds.

Cocoa consists of cacao seeds that have been ground up and roasted. Most cocoa products available to consumers has been further processed to remove the bitterness and add sweetness. Since the bitterness of cocoa is largely due to the flavanols, commercial cocoa products contain relatively small amounts of flavanols.

Chocolate is made by further processing of cocoa, mainly by adding sugar and fat.

Milk chocolate is a highly processed and sweetened product and is often subjected to a process of alkalinization ( or Dutching), which specifically removes flavanols to produce a smooth and sweetened product.

White chocolate is cocoa butter that has been removed from cacao seeds. It contains no chocolate solid products at all, specifically, it contains no flavanols, and should not be considered a true form of chocolate.

Dark chocolate is a chocolate product that is less processed than milk chocolate. It tends to contain more flavanols than milk chocolate, and partly, for this reason, it tends to be more bitter and less sweet than milk chocolate.

However, we should note that the actual “darkness” of chocolate has nothing to do with flavanol content - lots of Dutch-processed milk chocolate is quite dark in color.

Read about dark chocolate and health.

Notably, the stuff that is being used in the COSMOS study is not chocolate at all but is a cocoa flavanol supplement.

So Which Chocolate Products Are Good For Us?

Even assuming that studies like COSMOS will eventually demonstrate once and for all that cocoa-associated flavanols are heart healthy, we need to be aware that most of the chocolate and cocoa we can purchase today have had much of their flavanol content removed during processing.

At this point, it is generally very difficult for us to judge the flavanol content of commercially available chocolate and cocoa products. The Mars company seems the most serious about promoting the health benefits of chocolate and has introduced its flavanol-rich CocoaVia product line as a first step. CocoaVia products reveal their flavanol content on the product labels. Mars is also a sponsor of the COSMOS study, and presumably, is providing the flavonol supplement being used in that study. The Hershey company also claims its Special Dark chocolate product has a good flavanol content but has not published what that content actually is.

If chocolate manufacturers are serious about promoting chocolate as a healthy product, they will need to begin producing more flavanol-rich products, and label the flavanol content in the packaging.

In the meantime, we should keep in mind that despite all the hype, most of the chocolate we can purchase today is not medicinal. It’s candy.

Calories in chocolate candy.

Sources:
Dillinger TL, Barriga P, Escarcega S, Jiminez M, Salazar Lowe D, Grivetti LE. Food of the gods: the cure for humanity? A cultural history of the medicinal and ritual use of chocolate. J Nutr. 2000;130:2057S-2072S.
Latif R. Chocolate/cocoa and human health: a review. Neth J Med. 2013;71:63-68.
Grassi D, Necozione S, Lippi C, et al. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension. 2005;46:398-405.
Taubert D, Berkels R, Roesen R, Klaus W. Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. JAMA. 2003;290:1029-1030.

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More Evidence that Coronary Artery Disease Is Different In Women

More Evidence that Coronary Artery Disease Is Different In Women

In Women, Heart Attacks May Be Due to Erosions

For several years, cardiologists have known that coronary artery disease (CAD) in women can be quite different than it is in men. Women's symptoms may be different, the diagnostic tests that are used for

CAD can give the "wrong" answer in women, and the underlying disease itself can be quite different.

Here is a review of how CAD in women can be different from CAD in men.

It now appears that a new, possibly more significant difference has turned up.

Researchers have recently discovered that in younger women who have died suddenly from coronary thrombosis (blood clots that form in the coronary artery and obstruct blood flow), these fatal blood clots can be quite different than those in men who have suffered sudden death.

How Coronary Thrombosis Is Thought to Occur

Typically, acute coronary syndrome is caused by the rupture of an atherosclerotic plaque. The rupture exposes the "gunk" inside the plaque (cholesterol, calcium, inflammatory cells, and other material) to the bloodstream - and this can trigger the formation of a clot.

The if the clot causes complete (or nearly complete) obstruction of the coronary artery, blood flow to the portion of heart muscle supplied by that artery is shut off. This obstruction can lead to a heart attack (also known as a myocardial infarction), and all too often, can produce sudden cardiac death.

New Difference In CAD In Women

The new evidence suggests that in women under about 50 years of age (in particular, in pre-menopausal women), plaque rupture is often not the cause of the blood clot.

Instead, the clot may be triggered by erosion of the blood vessel wall.

What's the difference between a rupture and an erosion? Well, a rupture of a plaque is like a pimple that pops open. (In fact, the stuff inside a typical zit is not entirely unlike the stuff inside an atherosclerotic plaque.) But an erosion is more like a shallow ulcer - the plaque associated with an erosion may be quite small, or there may not be a plaque at all.

An erosion, like a plaque rupture, can cause the formation of a blood clot.

What The New Finding Means

This new information may partially explain why younger women with coronary thrombosis tend to do worse than men. Clots that form due to an erosion are often more dangerous than clots that form due to rupture. Erosion clots appear to form less suddenly, which means the clots have time to mature. So, when they cause obstruction, the obstruction is more likely to be difficult to reverse. 

Further, coronary artery erosions are difficult or impossible to see during cardiac catheterization or stress/thallium testing. So coronary artery erosions is yet another kind of coronary artery disease associated with "normal" coronary arteries. 

Who Gets Coronary Artery Erosions?

Coronary artery erosions is a condition almost always seen in premenopausal women, often in premenopausal smokers. So, while smoking is a risk factor for anyone, it is an especially strong risk factor for coronary artery erosions.

Coronary after erosions also may be more likely in women who have repeated spasms of the coronary arteries, such as in Prinzmetal's angina.

Summary

It is becoming increasingly obvious that CAD in younger women is very often a different disease than the "classic CAD" that is seen in men and in older women. The recognition of this fact is leading, at last, to efforts to gain a full understanding of those differences and to develop more effective strategies for treatment.

Sources:
Kramer MCA, Rittersma SZH, de Winter RJ, et al. Relationship of thrombus healing to underlying plaque morphology in sudden coronary death. J Am Coll Cardiol 2009; DOI:10.1016/j.jacc.2009.09.007.

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Smoking And Your Heart

Smoking And Your Heart

By Richard N. Fogoros, MD - Reviewed by a board-certified physician.
Updated April 26, 2016

Smoking tobacco is the strongest risk factor for developing heart disease.

In fact, the risk of having a heart attack is six times higher in smokers -- both men and women -- than in

people who never smoked. Worldwide, smoking is thought to account for almost 40% of first heart attacks.

Read about the risk factors for heart disease.
Not only does smoking cause heart disease, but once you develop heart disease, continuing to smoke makes it much worse, much faster.


People who keep smoking after a heart attack have a much higher risk of subsequent heart attacks. People who smoke after bypass surgery or stenting have a much higher incidence of developing occlusion of the bypassed or stented artery. Smokers with coronary artery disease (CAD) or heart failure have a substantially higher risk of premature death than non-smokers with these conditions.

How Does Smoking Cause Heart Disease?

Smoking tobacco greatly accelerates atherosclerosis, the disease process that produces CAD, heart failure, peripheral vascular disease, stroke, abdominal aortic aneurysms, and sudden death.

Smoking accelerates atherosclerosis in several ways:

Smoking increases LDL cholesterol (bad cholesterol) levels and reduces HDL cholesterol (good cholesterol).
Tobacco products contain chemicals that can irritate the blood vessel walls, increasing inflammation, damaging and "stiffening" the vessel walls -- all conditions that are associated with atherosclerosis.
Smoking increases adrenaline levels, which raises the blood pressure and cardiac stress, causing constriction of blood vessels.
Smoking abnormally increases the tendency of blood to form clots within blood vessels, thus increasing the risk of acute coronary syndrome (ACS).
In addition to accelerating atherosclerosis, smoking tobacco has other deleterious effects on the cardiovascular system.


The nicotine in tobacco contributes to the increase in heart rate and blood pressure seen after smoking a cigarette.

The Acute Effects Of Smoking A Cigarette
Several of the deleterious effects that are produced by smoking are relatively acute. Changes in the heart rate and blood pressure, the negative clotting effects, and even some of the chemical changes within the blood vessels can occur immediately when you light up.

The Cardiac Benefits Of Smoking Cessation
Just as smoking tobacco accelerates atherosclerosis, if you quit smoking you can slow the progression of atherosclerosis. Furthermore, smoking cessation actually substantially improves the overall function of your blood vessels. The risk of developing cardiovascular disease drops quickly after you quit smoking, and continues dropping the longer you remain tobacco-free.

After an episode of ACS, smokers who quit immediately have a much lower risk of dying in the near future, as compared to smokers who do not quit. Quitting also substantially reduces your risk of having a further episode of ACS.


Your risk of stroke also becomes substantially reduced over time after you quit smoking.

The benefits of smoking cessation are seen in both men and women in all age groups.

Why You Should Quit Right Now
Many of the adverse effects of smoking occur acutely -- right after you light up. This means that your chances of having an acute heart attack will actually diminish within 24 - 48 hours after your last smoke.

So not only should you quit smoking, you should quit smoking as soon as you possibly can.

Read more about why it is important to quit smoking right now.
Get help in quitting.

Sources:
Ambrose, JA, Barua, RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004; 43:1731.
Ockene, IS, Miller, NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation 1997; 96:3243.

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