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How Does Smoking Affect the Heart and Blood Vessels?

Cigarette smoking causes about 1 in every 5 deaths in the United States each year. It's the main preventable cause of death and illness in the United States.

Smoking harms nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. This article focuses on how smoking affects the heart and blood vessels.

Other Health Topics articles, such as COPD (chronic obstructive pulmonary disease), Bronchitis, and Cough, discuss how smoking affects the lungs.

Overview

Smoking and Your Heart and Blood Vessels

The chemicals in tobacco smoke harm your blood cells. They also can damage the function of your heart and the structure and function of your blood vessels. This damage increases your risk of atherosclerosis (ath-er-o-skler-O-sis).

Atherosclerosis is a disease in which a waxy substance called plaque (plak) builds up in the arteries. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Coronary heart disease (CHD) occurs if plaque builds up in the coronary (heart) arteries. Over time, CHD can lead to chest pain, heart attack, heart failure, arrhythmias (ah-RITH-me-ahs), or even death.

Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.

Smoking also is a major risk factor for peripheral arterial disease (P.A.D.). P.A.D. is a condition in which plaque builds up in the arteries that carry blood to the head, organs, and limbs. People who have P.A.D. are at increased risk for heart disease, heart attack, and stroke.

Smoking and Atherosclerosis

The image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral arterial disease. Figure B shows a detailed view of a leg artery with atherosclerosis—plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.

The image shows how smoking can affect arteries in the heart and legs. Figure A shows the location of coronary heart disease and peripheral arterial disease. Figure B shows a detailed view of a leg artery with atherosclerosis—plaque buildup that's partially blocking blood flow. Figure C shows a detailed view of a coronary (heart) artery with atherosclerosis.

Any amount of smoking, even light smoking or occasional smoking, damages the heart and blood vessels. For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.

Secondhand smoke also can harm the heart and blood vessels. Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.

Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. Secondhand smoke can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.

Secondhand smoke also raises children and teens' risk of future CHD because it:

  • Lowers HDL cholesterol (sometimes called "good" cholesterol)
  • Raises blood pressure
  • Damages heart tissues

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.

Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.

However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk for heart disease.

Benefits of Quitting Smoking and Avoiding Secondhand Smoke

One of the best ways to reduce your risk of heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.

Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members who smoke not to do it in the house and car.

Quitting smoking will reduce your risk of developing and dying from heart disease. Over time, quitting also will lower your risk of atherosclerosis and blood clots.

If you smoke and already have heart disease, quitting smoking will reduce your risk of sudden cardiac death, a second heart attack, and death from other chronic diseases.

Researchers have studied communities that have banned smoking at worksites and in public places. The number of heart attacks in these communities dropped quite a bit. Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.

Outlook

Smoking or exposure to secondhand smoke damages the heart and blood vessels in many ways. Smoking also is a major risk factor for developing heart disease or dying from it.

Quitting smoking and avoiding secondhand smoke can help reverse heart and blood vessel damage and reduce heart disease risk right away.

Quitting smoking is possible, but it can be hard. Millions of people have successfully quit smoking and remained nonsmokers. A variety of strategies, programs, and medicines are available to help you quit smoking.

Not smoking is an important part of a heart healthy lifestyle. A heart healthy lifestyle also includes following a healthy diet, maintaining a healthy weight, and being physically active.




What Are the Risks of Smoking?

The chemicals in tobacco smoke harm your heart and blood vessels in many ways. For example, they:

  • Thicken your blood and make it harder for your blood to carry oxygen.
  • Increase your blood pressure and heart rate, making your heart work harder than normal.
  • Lower your HDL cholesterol (sometimes called "good" cholesterol) and raise your LDL cholesterol (sometimes called "bad" cholesterol). Smoking also increases your triglyceride level. Triglycerides are a type of fat found in the blood.
  • Disturb normal heart rhythms.
  • Damage blood vessel walls, making them stiff and less elastic (stretchy). This damage narrows the blood vessels and adds to the damage caused by unhealthy cholesterol levels.
  • Contribute to inflammation, which may trigger plaque buildup in your arteries.

Smoking and Heart Disease Risk

Smoking is a major risk factor for coronary heart disease (CHD). CHD is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.

When plaque builds up in the arteries, the condition is called atherosclerosis.

Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

Over time, smoking contributes to atherosclerosis and increases your risk of having and dying from heart disease, heart failure, or a heart attack.

Compared with people who don't smoke, people who smoke can be up to two to three times more likely to have heart disease and twice as likely to have a heart attack. The risk of having or dying from a heart attack is even higher among people who smoke and already have heart disease.

For some people, such as women who use birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels.

Smoking is a major risk factor for heart disease. When combined with other risk factors—such as unhealthy blood cholesterol levels, high blood pressure, and overweight or obesity—smoking further raises the risk of heart disease.

Any amount of smoking, even light or occasional smoking, harms your body. Research suggests that smoking can even cancel out the benefits of other efforts to reduce heart disease risk, such as taking aspirin or medicines to lower cholesterol.

Smoking and Peripheral Arterial Disease Risk

Peripheral arterial disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Smoking is a major risk factor for P.A.D. Your risk of P.A.D. increases by four if you smoke or have a history of smoking.

P.A.D. usually affects the arteries that carry blood to your legs. Blocked blood flow in the leg arteries can cause cramping, pain, weakness, and numbness in your hips, thighs, and calf muscles.

Blocked blood flow also can raise your risk of getting an infection in the affected limb. Your body might have a hard time fighting the infection.

If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.

If you have P.A.D., your risk of heart disease and heart attack is six to seven times greater than the risk for people who don't have P.A.D.

Smoking even one or two cigarettes a day can interfere with P.A.D. treatments. People who smoke and people who have diabetes are at highest risk for P.A.D. complications, including gangrene in the leg from decreased blood flow.

Secondhand Smoke Risks

Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe. Secondhand smoke also refers to smoke that's breathed out by a person who is smoking.

Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. It can damage the hearts and blood vessels of people who don't smoke in the same way that active smoking harms people who do smoke. Secondhand smoke greatly increases adults' risk of heart attack and death.

Secondhand smoke also raises children and teens' risk of future CHD because it:

  • Lowers HDL cholesterol (good cholesterol)
  • Raises blood pressure
  • Damages heart tissues

The risks of secondhand smoke are especially high for premature babies who have respiratory distress syndrome (RDS) and children who have conditions such as asthma.

Cigar and Pipe Smoke Risks

Researchers know less about how cigar and pipe smoke affects the heart and blood vessels than they do about cigarette smoke.

However, the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes. Also, studies have shown that people who smoke cigars are at increased risk of heart disease.




What Are the Benefits of Quitting Smoking?

One of the best ways to reduce your risk of coronary heart disease is to avoid tobacco smoke. Don't ever start smoking. If you already smoke, quit. No matter how much or how long you've smoked, quitting will benefit you.

Also, try to avoid secondhand smoke. Don't go to places where smoking is allowed. Ask friends and family members to not smoke in the house and car.

Quitting smoking will benefit your heart and blood vessels. For example:

  • Heart disease risk associated with smoking begins to decrease soon after you quit. It continues to decrease over time. Your risk is cut in half 1 year after quitting. If you have not developed heart disease within 15 years of quitting, your risk is nearly the same as the risk in someone who has never smoked.
  • Deaths from heart disease are reduced by one-third in people who quit smoking compared with people who continue smoking. Repeat heart attacks are reduced by about the same amount.
  • People who smoke and already have heart disease lower their risk of sudden cardiac death, second heart attacks, and death from other chronic diseases by as much as half if they quit smoking.
  • Your risk of atherosclerosis and blood clots declines over time after you quit smoking.

Quitting smoking can lower your risk of heart disease as much as, or more than, common medicines used to lower heart disease risk, including aspirin, statins, beta-blockers, and ACE inhibitors.

In recent years, communities in Montana, Colorado, New York, Massachusetts, Indiana, and Ohio have banned smoking at worksites and in public places. Some countries, including Italy, Ireland, Norway, Scotland, and France, have put similar bans in place.

Studies of these communities show a rapid drop in the number of heart attacks within the first year of the ban. The number of heart attacks continues to decrease as time goes on.

Researchers think these results are due to a decrease in active smoking and reduced exposure to secondhand smoke.




Strategies To Quit Smoking

Quitting smoking is possible, but it can be hard. Millions of people have successfully quit smoking and remain nonsmokers. Surveys of current adult smokers find that 70 percent say they want to quit.

There are a few ways to quit smoking, including quitting all at once (going "cold turkey") or slowly cutting back your number of cigarettes before quitting completely. Use the method that works best for you. Below are some strategies to help you quit.

Get Ready To Quit

If you want to quit smoking, try to get motivated. Make a list of your reasons for wanting to quit. Write a contract to yourself that outlines your plan for quitting.

If you've tried to quit smoking in the past, think about those attempts. What helped you during that time, and what made it harder?

Know what triggers you to smoke. For example, do you smoke after a meal, while driving, or when you're stressed? Develop a plan to handle each trigger.

Get Support

Set a quit date and let those close to you know about it. Ask your family and friends for support in your effort to quit smoking.

You also can get support from hotlines and Web sites. Examples include
1–800–QUIT–NOW and http://smokefree.gov. These resources can help you set up a plan for quitting smoking.

Get Medicine and Use It Correctly

Talk with your doctor and pharmacist about medicines and over-the-counter products that can help you quit smoking. These medicines and products are helpful for many people.

You can buy nicotine gum, patches, and lozenges from a drug store. Other medicines that can help you quit smoking are available by prescription.

Learn New Skills and Behaviors

Try new activities to replace smoking. For example, instead of smoking after a meal, take a brisk walk in your neighborhood or around your office building. Try to be physically active regularly.

Take up knitting, carpentry, or other hobbies and activities that keep your hands busy. Try to avoid other people who smoke. Ask those you can't avoid to respect your efforts to stop smoking and not smoke around you.

Remove cigarettes, ashtrays, and lighters from your home, office, and car. Don't smoke at all—not even one puff. Also, try to avoid alcohol and caffeine. (People who drink alcohol are more likely to start smoking again after quitting.)

Be Prepared for Withdrawal and Relapse

Be prepared for the challenge of withdrawal. Withdrawal symptoms often lessen after only 1 or 2 weeks of not smoking, and each urge to smoke lasts only a few minutes.

You can take steps to cope with withdrawal symptoms. If you feel like smoking, wait a few minutes for the urge to pass. Remind yourself of the benefits of quitting. Don't get overwhelmed—take tasks one step at a time.

If you relapse (slip and smoke after you've quit), consider what caused the slip. Were you stressed out or unprepared for a situation that you associate with smoking? Make a plan to avoid or handle this situation in the future.

Getting frustrated with your slip will only make it harder to quit in the future. Accept that you slipped, learn from the slip, and recommit to quit smoking.

If you start smoking regularly again, don't get discouraged. Instead, find out what you need to do to get back on track so you can meet your goals. Set a new quit date, and ask your family and friends to help you. Most people who smoke make repeated attempts to quit before doing so successfully.

Many smokers gain weight after they quit, but the average weight gain is 10 pounds or less. You can control weight gain with a healthy diet and physical activity. Remember the bright side—food smells and tastes better if you aren't smoking.

For more information about how to quit smoking, go to the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart." Also, go to the U.S. Department of Health and Human Services' Smoking & How to Quit Web page and the Centers for Disease Control and Prevention's Smoking and Tobacco Use Web page.




Not Smoking as Part of a Heart Healthy Lifestyle

Not smoking is an important part of a heart healthy lifestyle. A heart healthy lifestyle also includes following a healthy diet, maintaining a healthy weight, and being physically active.

Following a Healthy Diet

A healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits.

A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, eggs, poultry without skin, seafood, nuts, seeds, beans, and peas.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.

Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, such as soda.

Also, limit the amount of solid fats and refined grains that you eat. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). Examples of refined grains include white rice and white bread.

If you drink alcohol, do so in moderation. Too much alcohol can raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which can cause weight gain.

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to Lowering Your Blood Pressure With DASH" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Maintaining a Healthy Weight

Being overweight or obese increases your risk of heart disease, even if you have no other risk factors. Overweight or obesity also raises your risk for other diseases that play a role in heart disease, such as diabetes and high blood pressure.

Your weight is the result of a balance between energy IN and energy OUT. Energy IN is the energy, or calories, you take in from food. Energy OUT is the energy you use for things like breathing, digestion, and physical activity.

If you have:

  • The same amount of energy IN and energy OUT over time, your weight stays the same
  • More energy IN than energy OUT over time, you'll gain weight
  • More energy OUT than energy IN over time, you'll lose weight

To maintain a healthy weight, your energy IN and energy OUT should balance each other. They don't have to be the same every day; it's the balance over time that's important.

Being Physically Active

Physical activity also is part of a heart healthy lifestyle. Physical activity is good for many parts of your body and can lower your risk for health problems.

Many Americans are not active enough. The good news, though, is that even modest amounts of physical activity are good for your health. The more active you are, the more you'll benefit.

The four main types of physical activity are aerobic, muscle-strengthening, bone strengthening, and stretching. You can do physical activity with light, moderate, or vigorous intensity. The level of intensity depends on how hard you have to work to do the activity.

For major health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week. Another option is to do a combination of both.

You don't have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each. Running, swimming, walking, bicycling, dancing, and doing jumping jacks are examples of aerobic activity.

If you have a heart problem or chronic disease, such as heart disease, diabetes, or high blood pressure, talk with your doctor about what types of physical activity are safe for you.

You also should talk with your doctor about safe physical activities if you have symptoms such as chest pain or dizziness.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has shown how smoking damages the heart and blood vessels. This research also has shown how quitting smoking can lower the risk of heart disease and improve overall health.

The NHLBI continues to support research on how smoking affects the heart and how to help people quit smoking. For example, NHLBI-supported research includes studies that explore:

  • Ways to help people who have high blood pressure quit smoking and prevent weight gain
  • Whether a phone-based support program and nicotine patches can help people in the military quit smoking
  • Whether an Internet- or phone-based support program can help people who live in rural areas with limited resources quit smoking
  • Interventions to help hospital patients quit smoking

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, procedures, or programs) are tested in volunteers. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to quitting smoking and disease prevention, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.




Links to Other Information About Smoking and Your Heart

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

 
December 20, 2011 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.

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