Why Quit Smoking?

You can reduce your risks. Smoking is the most important preventable cause of premature death in the United States. Smokers have a higher risk of developing many chronic disorders, including atherosclerosis — the buildup of fatty substances in the arteries — which can lead to coronary heart disease, heart attack (myocardial infarction) and stroke. Controlling or reversing atherosclerosis is an important part of preventing future heart attack or stroke You can modify or control six major independent risk factors for coronary heart disease: • • • • • • Cigarette and tobacco smoke High blood cholesterol High blood pressure Physical inactivity Overweight or obesity Diabetes

Smoking by itself increases the risk of coronary heart disease. When it acts with the other factors, it greatly increases your risk from those factors, too. Smoking decreases your tolerance for physical activity and increases the tendency for blood to clot. It decreases HDL (good) cholesterol. Your risks increase greatly if you smoke and have a family history of heart disease. Smoking also creates a higher risk for peripheral artery disease and aortic aneurysm. It increases the risk of recurrent coronary heart disease after bypass surgery, too. Smoking is also an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cerebrovascular system. Women who take oral contraceptives and smoke increase their risk of stroke many times. Cigars and pipes aren't a "safer" alternative to cigarettes. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), even though their risk isn't as great as that of cigarette smokers. Breathe clean air

It's also important to avoid other people's smoke. The link between secondhand smoke (also called environmental tobacco smoke) and disease is well known, and the connection to cardiovascular-related disability and death is also clear. Each year about 38,000 people die from heart and blood vessel disease caused by other people's smoke. Nonsmokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25–30 percent. Let healing begin today If you already have heart disease, you may think, "What good will it do me to quit smoking now?" But don't be discouraged. Your lungs can begin to heal themselves as soon as you stop harming them with more smoke. Heart disease can be prevented and controlled, but you must follow your treatment plan — and quitting smoking is a big part.

Smoking: Do you really know the risks?

You probably know about the relationship between smoking and lung cancer, but did you know smoking is also linked to heart disease, stroke and other chronic lung diseases? Smoking can also increase your risk for cancer of the bladder, throat and mouth, kidneys, cervix and pancreas. Thinking about quitting? Look at the facts! Why you should quit? • • • • • • Smoking is the most preventable cause of death in the United States. Smoking causes more than one in five deaths in America. 90 percent of lung cancer in men is directly related to smoking and 80 percent of lung cancer in women is caused by cigarettes. About 23 percent of adult men and about 18 percent of adult women smoke. The highest percentage of people who smoke are between the ages of 25 and 44. According to the American Heart Association, most adult smokers started smoking when they were preteens or teenagers. Unfortunately, many young people don’t fully understand the dangers of smoking. About 60 percent of American children ages 4-11 are exposed to secondhand smoke at home. On average, smokers die 13 to 14 years earlier than nonsmokers. Since 1965, more than 45 percent of adults who have ever smoked have quit. You can be one of the millions of people who successfully quit every year.

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What makes cigarettes so toxic and dangerous? There are 4,000 chemical components found in cigarettes and at least 250 of them are harmful to human health, according to the Centers for Disease Control and Prevention. Here are a few examples: • 1,3-Butadine is a chemical used to manufacture rubber. According to the CDC, “it may increase risk of cancer in the stomach, blood and lymphatic system.”

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Acrolein is a gas linked to lung cancer. It inhibits DNA repair and can destroy the lining in the lungs that protects you from lung disease. Arsenic is used to preserve wood. In humans, it can cause heart disease and cancer. Benzene is used to manufacture other chemicals. It can cause cancer, particularly leukemia, in humans. Cadmium is a metal used to make batteries. Cadmium can interfere with the repair of damaged DNA, as well as damage the kidneys and the lining of the arteries. Chromium VI is used to make alloy metals, paint and dyes. It has been proven to be linked to lung cancer. Formaldehyde is a chemical used to kill bacteria and preserve human and animal remains. It’s a known cause of cancer, one of the main substances linked to chronic lung disease and a very toxic ingredient in secondhand smoke. Polonium-210 is a radioactive element inhaled directly into the airway. Some studies show that people who smoke a pack-and-a-half of cigarettes a day are receiving the same radiation they’d get from 300-plus X-rays per year! Tar is solid, inhaled chemicals linked with an increased risk for cancer. It also leaves a sticky, brown residue on your lungs, teeth and fingernails.

Carbon monoxide & nicotine: A dangerous duo Carbon monoxide is a harmful gas you inhale when you smoke. Once in your lungs, it’s transferred to your bloodstream. Carbon monoxide decreases the amount of oxygen that is carried in the red blood cells. It also increases the amount of cholesterol that is deposited into the inner lining of the arteries which, over time, can cause the arteries to harden. This leads to heart disease, artery disease and possibly heart attack. Nicotine is a dangerous and highly addictive chemical. It can cause an increase in blood pressure, heart rate, flow of blood to the heart and a narrowing of the arteries (vessels that carry blood). Nicotine may also contribute to the hardening of the arterial walls, which in turn, may lead to a heart attack. This chemical can stay in your body for six to eight hours depending on how often you smoke. Also, as with most addictive substances, there are some side effects of withdrawal. Second-Hand Smoke Smokers aren’t the only ones affected by tobacco smoke. Secondhand smoke is a serious health hazard for nonsmokers, especially children. Cigarette smoke contains more than Nonsmokers who have high blood pressure or high blood cholesterol have an even greater risk of developing heart diseases when they’re exposed to secondhand smoke. Environmental tobacco smoke causes about 46,000 heart disease deaths and 3,400 lung cancer deaths. Studies show that the risk of developing heart disease is about 25-30 percent higher among people exposed to environmental tobacco smoke at home or work. Secondhand smoke promotes illness, too. Children of smokers have many more respiratory infections than do children of nonsmokers. Nonsmoking women exposed to tobacco smoke are also more likely to have low-birthweight babies. Excerpted and adapted from "When Risk Factors Unite," appearing in the Stroke Connection Magazine January/February 2005 (Science update May 2008) These are just a few of the dangerous chemicals found in cigarettes; there are many more. But you do not have to spend the rest of your life giving in to your addiction! Thousands of people kick the habit every year, and you can be one of them. It may not be easy, but you can do it!

How Cigarettes Damage Your Body

Cigarette smokers have a higher risk of developing cardiovascular disease. Here’s why. Factors like high blood pressure can stretch out the arteries and cause scarring. Bad cholesterol, called LDL, often gets lodged in the scar tissue and combines with white blood cells to form clots. The good cholesterol, called HDL, helps keep the LDL from sticking and building up. Here are some other problems smoking causes • • • • Smoking robs you of some of your good cholesterol. Smoking temporarily raises your blood pressure. Smoking increases the blood’s clotting likelihood. Smoking makes it more difficult to exercise.

Although cigarette smoking alone increases your risk of coronary heart disease, it greatly increases risk to your whole cardiovascular system. Smoking also increases the risk of recurrent coronary heart disease after bypass surgery. Atherosclerosis is the buildup of fatty substances in the arteries, and is a chief contributor to heart disease – the No. 1 killer in America. Stroke risks are higher, too. Because smoking temporarily increases blood pressure, and also increases cholesterol build-ups and the tendency for blood to clot, both types of strokes are more likely for a person who smokes. There are strokes caused from bleeding because of a weakened blood vessel and strokes caused by blockages and clots that form in a vessel and cut off blood flow to the brain. Stroke is one of the leading causes of death and adult disability in America. Smoking also contributes to peripheral artery disease. Again, because of the added strain smoking places on the arteries and veins, peripheral artery disease is much more like among smokers, and the habit also further increases the risk for aortic aneurism. There is hope and help Despite all these scary facts, there is hope if you’re a smoker. Did you know that almost immediately after you quit smoking, your lungs and other smoke-damaged organs start to repair themselves? You can start getting better the day you put down the cigarettes. See how this process happens in the Smoke-Free Living– Benefits & Milestones. Lung and breathing problems Your lungs are “air-exchange organs.” They’re made up of tubes that branch out into small sacs called bronchioles and alveoli where oxygen exchange takes place. Your body takes in the oxygen you breathe and uses it as fuel. When you breathe in, the sacs inflate. When you breathe out, the sacs deflate. In a healthy person, these tubes and sacs are very elastic and spongy. In a person with a chronic lung disease, these sacs lose their elasticity and oxygen exchange is greatly impaired. When that happens, your body is in grave danger because we can’t live without oxygen! The lungs protect themselves with a thin layer of protective mucus and by moving toxic particles out with small hairs. In a smoker’s lungs, the small hairs, called cilia, move slower and struggle to remove harmful particles. You can’t cough, sneeze or swallow effectively to clear these toxins. They become trapped in

your lungs, leading to higher risk for numerous dangerous health problems, including heart disease, stroke and cancer. Chronic obstructive pulmonary disease is usually made up of two conditions that make breathing difficult: emphysema and chronic bronchitis. When you have emphysema, the air sacs in your lungs start to deteriorate and lose their elasticity. Chronic bronchitis occurs when the lining in the tubes in your lungs swell and restrict your breathing. These conditions are directly related to smoking.

Medicines To Help You Quit Smoking

Medicines can help you quit smoking when you use them correctly. Nicotine replacement medicines contain gradually decreasing doses of nicotine to help reduce the headaches and irritability you may have when you quit smoking. Non-nicotine prescription medicines can also help you quit by making nicotine cravings less severe. Your doctor or nurse can help you decide if one of these medicines might help you. Your doctor may also decide that using both a nicotine replacement medicine and a non-nicotine replacement medicine may work better for you. When you talk to your doctor or nurse, ask how to use the medicine. Studies show that many people don't use their quit-smoking medicines correctly. If you don't use the medicine properly, it won't work well for you. The information sheet that comes with your medicine tells you exactly how to use the medicine. Nicotine Replacement Medicines You can't use nicotine replacement medicines if you keep smoking or use other tobacco products. The combined use of nicotine can be dangerous. You must stop smoking completely when you begin using a nicotine replacement medicine. Nicotine replacement treatment usually lasts from two to three months. Even though you can buy many products without a prescription, talk to your doctor first about which medicine is best for you. Nicotine Chewing Gum or Lozenges Nicotine gum has helped people quit smoking for 20 years. You can buy the gum or lozenges in a drug store without a prescription. Be sure to read the instructions and use the gum or lozenges correctly. • Try to chew a piece of gum or suck a lozenge every one to two hours that you're awake, but don't use more than 20 pieces per day if you use 4 mg gum or lozenges, or 30 pieces per day if you use 2 mg gum or lozenges. The number of pieces you use per day will decrease over time. Don't drink coffee, orange juice, cola or alcohol for 15 minutes before or while using a piece of gum or lozenge. These drinks make the nicotine replacement less powerful. If you don't use nicotine gum or lozenges correctly, you may have side effects such as mouth and throat discomfort. You may need to use nicotine gum or lozenges for three months.

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Nicotine Patch You don't need a doctor's prescription to buy the nicotine patch. The patches may come in different strengths: some brands are available in 5, 10 and 15 mg strengths; others may come in 7, 14 and 21 mg

strengths. Read the package to determine what strength you should start using, depending on the amount you smoke. Taper down to the lower-strength patches on the recommended schedule. • • • • Wear the patch on your chest or high on your arm. Put on a new patch every 16 or 24 hours. If you have trouble sleeping or have disturbing dreams, remove the patch when you go to bed and put on a new one as soon as you get up. You may swim, shower and perform physical activity with the patch. Side effects may include redness and soreness under the patch. To reduce these side effects, change the location of the patch each day.

Nicotine Spray To buy the nicotine spray, you need a prescription from your doctor. • • • The spray goes in your nose, one or two times per hour, when you're awake. The spray may cause coughing, runny nose or watery eyes during the first week or two. These side effects get better over time. You may need to use nicotine spray for up to six months, but taper off starting at or before three months.

Nicotine Inhaler The nicotine inhaler is a vapor (mist) that you breathe into your mouth and upper chest. • • • You'll use between six and 16 cartridges (tubes) each day. When you first use it, the nicotine inhaler may cause mild throat or mouth discomfort. You may need to use the inhaler for up to six months, but taper off starting at or before three months.

No tobacco product is safe. Smokeless tobacco should not be used for smoking cessation because longterm use moderately increases the risk of a fatal heart attack, fatal stroke and certain cancers. It is also addictive – smokeless tobacco users often experience the same withdrawal symptoms as individuals who stop smoking cigarettes. Funding for comprehensive tobacco control and prevention programs in many states remains inadequate. The American Heart Association strongly advocates increased funding for effective and accessible tobacco cessation programs. Approximately one-third of tobacco users will die prematurely because of their dependence on tobacco unless treatment efforts are increased. Non-Nicotine Prescription Medicines Some of the major types of commonly prescribed smoking-cessation medicines are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products. If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information. It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your doctor. Bupropion hydrochloride is a medicine for depression, but it also helps people quit smoking. Brand names include Zyban®, Wellbutrin®, Wellbutrin SR® and Wellbutrin XL® but this medication is also available as a generic.

Varenicline is a relatively new medicine that may help smokers quit. It is currently available under the brand name Chantix®. • • • • Both medicines work by blocking the flow of chemicals in the brain that make you want to smoke. Both medicines come in pill form. You start out with a low dose and gradually increase up to the full dose. It takes about a week for these medicines to work, so you need to start taking them before you quit smoking. Each of these medicines may interact differently with other medicines you're taking. Make sure your doctor and pharmacist have a complete list of all your medicines, including over-the-counter drugs, supplements and herbal medicines. You may need to use a non-nicotine prescription medicine for seven to 12 weeks or longer, as your doctor recommends. When you get ready to stop taking a non-nicotine prescription medicine, you may need to take a gradually decreasing dose before you stop completely. The FDA notified the public that the use of varenicline or bupropion has been associated with reports of behavior changes including hostility, agitation, depressed mood, and suicidal thoughts or actions. The FDA is requiring the manufacturers of these products to add a new Boxed Warning to the product labeling to alert healthcare professionals to this important new safety information. While taking these drugs, if you experience any serious and unusual changes in mood or behavior or feel like hurting yourself or someone else, you should stop taking the medicine and call you healthcare professional right away. Friends or family members who notice these changes in behavior in someone who is taking varenicline or bupropion for smoking cessation should tell the person their concerns and recommend that he or she stop taking the drug and call a healthcare professional right away. For more information about the FDA's warnings about varenicline and bupropion, read our press release.

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