[Adverse cardiac effects of smoking]

Cigarette smoking is a main risk-factor for enhanced cardiovascular morbidity and mortality. Some studies have even suggested that unvoluntary smoking increases the atherosclerotic risk. Smoking related cardiovascular diseases include coronary heart disease, acute myocardial infarction, sudden death, stroke, aortic aneurysm, atherosclerotic peripheral vascular disease. Risk is potentiated in patients with other coronary risk-factors i.e. hypertension and/or hypercholesterolemia. It is also proportionately related to the number of cigarettes smoked daily and smoking behavior. Combination of cigarette smoking and oral contraceptive use is the major cause of coronary events in female smokers under 50 years. Risk will be reduced only be smoking cessation. Underlying pathophysiologic mechanisms are complex; nicotine- and carbon-monoxide induced deleterious effects will be found on hemodynamic parameters, lipid status and hemorheology. Although clinical events due to acute coronary thrombosis and vasoconstriction are more often in smokers than in nonsmokers, angina pectoris is less common. Furthermore smoking diminishes beneficial effects of well established therapeutical procedures in treatment of coronary heart disease. Therefore, smoking cessation therapy should be a major goal for primary and secondary prevention programs as well.