[Medical and psychological problems of smoking]

In the medical part of this review the devastating role of the "modern plague" smoking is exposed. The numerous and variable diseases of this habit or dependence are depicted. The most serious consequences of smoking concern--next to pulmonary diseases--the vascular system. Smokers are at risk for ischemic heart disease, cerebrovascular insults, peripheral arterial occlusive disease and thoracic and abdominal aortic aneurysms. The pathogenic mechanisms promoting atherosclerosis and thrombosis are reviewed: smoking promotes atherogenesis on one hand, on the other hand it initiates thrombotic and spastic vascular occlusion. Sympathico-adrenergic and hemostatic mechanisms thus affect the coronary system, partly in a reversible manner. This view is supported by the high incidence of mainly acute coronary events (infarction, instable angina, ventricular fibrillation) in smokers with rapidly improved prognosis after tobacco withdrawal. In the psychologic part of the review smoking is viewed as self-medication, and the attempt is made to depict the various types of smokers and their psychologic profiles.