Skip to Main Content


This chapter discusses the epidemiology of cigarette smoking, particularly with regard to cardiovascular disease, and the pathophysiology of smoking-induced cardiovascular damage (see accompanying Hurst’s Central Illustration). The majority of smokers are male. Globally, cigarette smoking is the leading cause of preventable cardiovascular morbidity and mortality, with around one in ten cardiovascular deaths still attributed to smoking. Smoking has been associated with the development of multiple cardiovascular conditions, including atherosclerosis, myocardial infarction, stroke, peripheral arterial disease, and abdominal aortic aneurysms. Three constituents of cigarette smoke have been shown to have a role in the initiation and progression of cardiovascular disease: nicotine, carbon monoxide (CO), and reactive oxygen species (ROS). Nicotine is the main cause of the smoking-induced hemodynamic changes, although CO has also been implicated. Free radicals, ROS, and reactive aldehydes from cigarette smoke are involved in the development of endothelial dysfunction, through negative effects on endothelial nitric oxide (NO) production. Various components of cigarette smoke have been shown to induce processes involved in cardiac remodelling, and cigarette smoke is also known to induce a prothrombotic state, vascular inflammation, alterations of lipid profile, and changes to glucose metabolism.

eFig 30-01

Hurst’s Central Illustration: Pathogenesis of Smoking-Induced Cardiovascular Disease.

Pathogenesis of cigarette-smoking-induced cardiovascular disease.


This chapter provides an epidemiological overview of cigarette smoking and its impact on health, with a focus on cardiovascular diseases. Although smoking-related pathophysiological changes are discussed in all relevant chapters, this chapter aims to provide a synopsis of smoking-related pathological changes in the cardiovascular system. As health care providers striving to improve cardiovascular health, we are uniquely positioned to promote smoking cessation through counseling and clinical support for both primary and secondary prevention. Chapter 31 discusses the clinical management of patients to prevent and mitigate the adverse effects of smoking. The seriousness, resources, and political will to counterbalance the strong interest and position of the smoking industry may be catching up after a lag of almost half a century. There are growing concerns about (1) an increase in the total number of smokers worldwide with population growth despite a reduction in smoking rates, (2) an increasing prevalence of smoking among young adults and in developing countries, and (3) an increasing uptake of electronic cigarettes (e-cigarettes) ahead of research examining its health effects.


Tobacco Control: A Long and Arduous Journey

Although the Surgeon General’s report in 1957 concluded that cigarette smoking is associated with an increased risk of lung cancer, it was not until publication of the landmark 1964 Surgeon General’s report that the adverse relationship between cigarette smoking and cardiovascular disease was seriously recognized. The Surgeon General’s report concluded that cigarette smoking is strongly associated with myocardial infarction and coronary heart disease deaths, and it laid the foundation for tobacco control.1 Unfortunately, ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.