[Smoking and smoking cessation in the context of preventive cardiology]

Knowledge about the effects of smoking on the development of cardiovascular disease is constantly growing. As an example, we know today that myocardial infarction is more frequent among smokers, also among monozygous twins, and that the relative risk of women who smoke is comparable to that of male smokers. The mechanisms of action are in atherogenesis, in the stimulation of the adrenergic system and in an increase of plasma fibrinogen. In order to best support his patients to give up smoking, the practicing physician has to be aware of the factors influencing the smoking habit. The parallel development of psychological dependence and physical addiction to nicotine is described, and it is shown how nicotine substitution therapy can help to stagger psychological and physical withdrawal. The introduction of transdermal nicotine substitution opens new possibilities in this context.