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EBMG

The Most Important Known Health Risks of Smoking

Smoking, mortality and risk of disease

  • Smoking is the most important preventable cause of death.
  • People who smoke have a 2-3-fold risk of premature death compared with those who do not smoke Smoking and Total Mortality. Women are more susceptible to tobacco-induced diseases than men.
  • In a study performed among British male doctors, the probability of dying in the middle age (45-64 years) was 3-fold and in the retired age (65-84 years) 2-fold among smokers compared to those who had never smoked. The increase in risk is correlated to the quantity of cigarettes and duration of smoking. The risk diminishes after stopping smoking Reduction of Cardiovascular Risk after Stopping Smoking. Smoking shortens the lifespan by 10 years; quitting at the age of 60, 50, 40 or 30 increases life expectancy by 3, 6, 9 or 10 years, respectively, compared to those who continue smoking.
  • Smoking is associated with an increased risk of developing and dying of cancer Association Between Smoking and Incidence of Cancer.
    • The risk of lung cancer is on average about 6- to 21-fold, and it rises with increased consumption of cigarettes. 90% of lung cancers are caused by smoking.
    • The risk of cancer of mouth, pharynx, pancreas or oesophagus is 6- to 8-fold.
    • Smoking also increases the risk of other cancers to 1.5- to 3-fold (cancer of urinary bladder, kidney, stomach, liver, colon or cervix; leukaemia).
  • The risk of myocardial infarction and cerebral and peripheral vascular diseases increases by 50%, and it increases in a dose-dependent way. In persons less than 60 years of age, the risk of ischaemic heart disease is 2- to 5.5-fold and the risk of cerebral infarction is 3- to 4-fold.
  • Smoking appears to increase the risk of dementiaSmoking and Dementia.
  • Smoking causes intermittent claudication and may cause impotence.
  • In women, smoking increases synergistically the risk of thromboembolic complications associated with the use of oral contraceptivesIschaemic Stroke and Myocardial Infarction Risk with Combined Oral Contraceptives, advances climacterium and increases the risk of urinary incontinence.
  • Smoking causes COPD (10- to 12-fold risk); about 80% of COPD mortality is associated with smoking.
  • Acute respiratory infections and chronic bronchitis are much more common in smokers compared with non-smokers.
  • The risk of gastric or duodenal ulcer is increased.
  • Smoking can act additively or synergistically with chemicals at work and increase the risk of occupational diseases.
  • Mother's smoking increases perinatal mortality as well as the risk of sudden infant death and preterm birth Changes in Smoking during Pregnancy and Risks of Adverse Birth Outcomes and Childhood Overweight, and decreases the birth weight of the newborn by approximately 200 g Changes in Smoking during Pregnancy and Risks of Adverse Birth Outcomes and Childhood Overweight. Smoking cessation during pregnancy may reduce the incidence of prematurity and low birth weightPsychosocial Interventions for Supporting Women to Stop Smoking in Pregnancy. Smoking also decreases fertility and increases the risk of miscarriage and ectopic pregnancy.
  • Smoking increases the frequency of surgical complications and impairs healing of surgical woundsInterventions for Preoperative Smoking Cessation.
  • The skin ages prematurely.

Exposure to tobacco smoke (passive smoking)

  • Passive smoking increases the risk of lung cancer by approximately 25%. The risk of lung cancer has also been shown at the individual level.
  • The risk of coronary events at the population level is 25-30% higher compared with non-exposed indivuals. The risk of all persons exposed to environmental tobacco smoke is about half of the additional risk that active smokers have. The risk is dose-dependent, i.e. it grows with increasing exposure. The risk has not been proven at the individual level as it has been for lung cancer.
  • The increased risk of stroke appears to be of a similar magnitude as that of coronary artery disease.
  • Exposure causes inflammatory changes in the respiratory tract and suppresses the immune response and function of the pulmonary epithelium cilia, leading to increased susceptibility to respiratory infections and possibly also to asthma and COPD.
  • In children, exposure increases susceptibility to respiratory infections and otitides as well as the risk of onset and exacerbation of asthma.

Other harmful effects of smoking

  • Nicotine causes strong dependence that can be compared to that of narcotic substances.
  • Smoking can alter the clinical effects of various drugs. Proton pump inhibitors prevent recurrence of ulcer much less in smokers than in those who do not smoke. Smoking decreases the efficacy of angina pectoris medication and diuretics. Tobacco smoke induces CYP1A2 activity and thus accelerates the metabolism of certain pharmacological agents: heparin, warfarin, theophylline, flecainide, propranolol, benzodiazepines, chlordiazepoxide, haloperidol, clozapine, olanzapine and estradiol. Smoking reduces cutaneous superficial circulation thus decreasing the absorption of subcutanously injected insulin.

Snuff (smokeless tobacco)

  • Contains carcinogenic nitrosamines.
  • Increases the risk of cancer in the oral cavity, oesophagus and pancreas.
  • The risk of fatal myocardial infarction and stroke is increased.

Electronic cigarettes (electronic nicotine delivery systems)

  • In electronic cigarettes, propylene glycol or glycerol liquid is heated up with a battery. The vapour contains carcinogenic agents (polycyclic aromatic hydrocarbon compounds, among others) and sometimes also silicate and metal particles. The use of electronic cigarette containing nicotine causes strong dependence. Electronic cigarettes interfere with pulmonary function and increase the risk of cardiovascular diseases, but knowledge of long-term effects is insufficient.
  • In 2019, electronic cigarette use associated lung injury (e-cigarette or vaping product use associated lung injury [EVALI]) and deaths were found in the United Sates. In addition to the symptoms of respiratory passages and gastrointestinal tract, fever and other general symptoms appeared. In the majority of the cases, tetrahydrocannabinol and vitamin E acetate was found in the used product.
  • People passively exposed to e-cigarette vapour show blood nicotine concentrations that may be as high as those found in people exposed to tobacco smoke.

    References

    • Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ 2004 Jun 26;328(7455):1519. [PubMed]
    • Centers for Disease Control and Prevention (CDC). CDC grand rounds: current opportunities in tobacco control. MMWR Morb Mortal Wkly Rep 2010;59(16):487-92. [PubMed]
    • Danaei G, Ding EL, Mozaffarian D et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6(4):e1000058. [PubMed]
    • Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3(11):e442. [PubMed]
    • Hackshaw A, Morris JK, Boniface S et al. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ 2018;360():j5855. [PubMed]
    • Qiao Q, Tervahauta M, Nissinen A et al. Mortality from all causes and from coronary heart disease related to smoking and changes in smoking during a 35-year follow-up of middle-aged Finnish men. Eur Heart J 2000;21(19):1621-6. [PubMed]
    • Mucha L, Stephenson J, Morandi N et al. Meta-analysis of disease risk associated with smoking, by gender and intensity of smoking. Gend Med 2006;3(4):279-91. [PubMed]
    • Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer 2012;12():385. [PubMed]
    • Pirie K, Peto R, Reeves GK et al. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 2013;381(9861):133-41. [PubMed]
    • National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. 2014;. [PubMed]
    • Kennedy CD, van Schalkwyk MCI, McKee M et al. The cardiovascular effects of electronic cigarettes: A systematic review of experimental studies. Prev Med 2019;127:105770. [PubMed]
    • Peruzzi M, Biondi-Zoccai G, Carnevale R et al. Vaping Cardiovascular Health Risks: an Updated Umbrella Review. Curr Emerg Hosp Med Rep 2020:1-7.[PubMed]
    • Norwegian Institute of Public Health. (2019). Health risks from snus use (English summary)http://www.fhi.no/en/publ/2019/health-risks-from-snus-use2/
    • National Cancer Institute (NCI) & Centers for Disease Control and Prevention (CDC) (2014) Smokeless Tobacco and Public Health: A Global Perspective. Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute. NIH Publication No. 14-7983; 2014.http://cancercontrol.cancer.gov/brp/tcrb/smokeless-tobacco

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