[Smoking, cardiovascular diseases and possibilities for treating nicotine dependence]

Diseases of the cardiovascular system such as coronary heart disease, hypertesion, peripheral occlusive arterial disease, and their final or lethal states (acute myocardial infarction, apoplectic stroke, congestive heart failure) occur 3 to 4 times more frequently than lung cancer in heavy smokers. Cigarette smoking impairs the courses of the microcirculation by an elevated viscosity of the blood or plasma, by a diminished deformability of the red blood cells, by elevated white cell counts, by activation of several blood clotting factors such as factor XIII and von Willebrand factor, by an elevated aggregability of the blood platelets, and by an increased uptake of fibrinogen into the endothelium of the blood vessels. After cessation of smoking these effects are widely normalized even though nicotine is still administered. Proposals for the cessation of smoking and for the use of nicotine replacement (patch, chewing gum, etc.) were offered because the inhaled tobacco smoke mainly damages health while the smokers are addicted only by nicotine. A less restrictive distribution of nicotine preparations for replacement therapy should enable the heavy smoker in his first phase of smoking cessation to combine the nicotine administration with reduced cigarette smoking. Each decrease in the carbon monoxide content of the expired air with subsequent decrease in the carboxyhemoglobin content of the blood possibly diminishes the risk of cardiovascular events. This way of treatment gives new opportunities for the treatment of the smoking patient for every physician.