It is certainly no secret that smoking cigarettes is not just a poor lifestyle choice, but is also harmful and, in most cases, shortens life expectancy. Even in the 1930s, cigarettes were slangly referred to as “coffin nails.” Cigarette smoking has been linked to heart disease and cancers, the two leading causes of death in the world. Recent evidence suggests a higher cancer incidence among patients with preexisting cardiovascular disease, including heart failure and heart attacks, as compared to the general population. Additionally, in the past few decades, a shift in the cause of death after myocardial infarction (MI, aka heart attack) from cardiovascular to non-cardiovascular disease has been documented, with cancer becoming the main cause. Research has shown that cardiovascular disease and cancer are more closely related than had previously been thought. Smokers are overrepresented among cardiac patients and face a worse prognosis than non-smokers. Smoking cessation after an MI instantly improves the prognosis.
Late last year, a study called the Israel Study of First Acute Myocardial Infarction was published. This study, done in Tel Aviv from 1992 to 1993, enlisted about 1500 people aged 65 and younger who were admitted to eight Israeli medical centers for heart attacks. These people were then followed for an average of 21 years. Smoking history, incidence of cancer development, diabetes, and other factors were recorded. When the study began, about half of the study participants were smokers (average daily cigarette consumption = 29). The smokers were younger than the non-smokers and were more likely to be male and of lower socioeconomic status. Over the course of the study 18.4 percent of participants developed cancer. Baseline (at the start) smoking was associated with a 40 percent excess risk of cancer and a 25 percent risk of early death. Within one year of quitting smoking, heart disease risk was reduced by half and reached the risk of non-smokers between five and 15 years after quitting and, although the cancer risk remained higher for those who quit and those who continued to smoke as compared to those who never smoked, cancer risk did go down for those who quit. Among those who continued to smoke, each reduction of 10 cigarettes relative to pre-MI consumption lowered the risk of further heart disease by 10 percent and lowered the cancer risk as well but by less.
This was the first study to provide strong evidence for lower cancer risk in people who quit smoking before and even after a heart attack. Many other studies have shown that quitting smoking lowers the risk of heart disease significantly, but this was the first study to look at both heart disease and cancer risks for smokers. This calls for more smoking cessation counseling for survivors of a heart attack, especially younger survivors, as well as more smoking cessation counseling for all smokers.
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