The “Smoking Gun” in Heart Disease

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After more than 40 years as a clinical cardiologist, I've learned firsthand about the cardinal relationship between smoking and heart disease.

Smoking kills 480,000 Americans every year, shortens life expectancy by 10 years, and is our single greatest preventable cause of disease and death. In addition to precipitating chronic obstructive pulmonary disease (COPD) and nine out of 10 cases of lung cancer, this highly addictive habit wreaks havoc throughout your body—including your cardiovascular system.

How Smoking Harms Your Heart

You’d expect smoking to harm the lungs. After all, many of the 7,000 chemicals in tobacco smoke, which is delivered directly to the lungs, are toxic and at least 69 are carcinogenic.

But what about cardiovascular disease? When smoke is inhaled, many of these toxins are rapidly absorbed into the bloodstream. So, your blood vessels also take a direct hit—with devastating consequences.

  • Oxidative stress. Tobacco smoke is loaded with free radicals, which set off a chain reaction of oxidation that damages the endothelial cells that line the arteries and play a key role in cardiovascular health.
  • Nutrient depletion: Smoking severely depletes essential antioxidants like vitamin C and vitamin E, which are needed to curb free radicals and prevent oxidative stress.
  • Inflammation. Inflammation is your body’s response to injury—including arterial injury—and cardiovascular disease is closely associated with chronic low-level inflammation.
  • Cholesterol abnormalities. Smoking lowers protective HDL cholesterol and raises LDL cholesterol. It also intensifies the oxidation of LDL, which damages the arteries.
  • Thicker, stickier blood. Toxins in smoke make the blood thicker, which slows flow and the delivery of nutrients and oxygen, makes the heart work harder, and increases the likelihood of clots.
  • Rise in carbon monoxide & decline in oxygen levels. Smoking causes a buildup of carbon monoxide, which robs your body of oxygen. A smoker might as well hook himself up to the tailpipe of his car!
  • Changes in heart rate & rhythm. Nicotine has a stimulating effect on the heart’s electrical system, which can make the heart beat faster, harder, or irregularly.
  • Blood vessel damage. The combination of these destructive processes significantly harms your blood vessels, setting the stage for atherosclerosis (the buildup of plaque) and stiffer, narrower, less elastic and responsive arteries.

What Cardiovascular Problems Are Related to Smoking?

Does smoking raise blood pressure?

Yes! Smoking causes narrowing and stiffening of the blood vessels and changes in blood flow which force the heart to work harder to pump blood through the body—raising your blood pressure. Plus, the rise in blood pressure causes further arterial damage and is a significant risk factor for multiple cardiovascular disorders.

Can smoking cause a heart attack?

For all the reasons listed above, smoking is a powerful risk factor for coronary artery disease. When plaque builds up in the coronary arteries, it limits blood flow and oxygen delivery to the heart muscle. A heart attack occurs when a coronary artery becomes blocked (usually by a blood clot), cuts off blood flow to the heart, and part of the heart muscle dies. Compared to nonsmokers, smokers are twice as likely to have heart attacks.

How about a stroke?

Most strokes are a result of a blood clot blocking an artery in or leading to the brain. Deprived of blood, oxygen, and nutrients, brain cells in the affected area die or are severely impaired. Because smoking is linked with risk factors for stroke such as high blood pressure and arterial damage, it significantly increases your likelihood of having a stroke.

Does smoking cause heart valve problems?

Smoking can raise blood pressure, which in combination with other maladaptive lifestyle habits may lead to exacerbation of leaking heart valves.

Does smoking cause heart palpitations?

Nicotine’s stimulating effect on heart rate and rhythm is a fairly common cause of palpitations. Elevated carbon monoxide levels in smokers also have adverse effects on the heart and can cause arrhythmias.

Can smoking cause congestive heart failure?

Smoking is clearly linked with hypertension, coronary artery disease, and heart attack, which increase the risk of congestive heart failure. Smoking also worsens existing heart failure. Patients who continue to smoke despite heart failure have a greater likelihood of exacerbating their condition.

What about sudden cardiac death?

A 2018 meta-analysis found that current smokers have a three-fold greater risk of sudden cardiac death than people who have never smoked. Overall, one in four cardiovascular deaths are due to smoking.

Help for Breaking the Habit

I believe that biting the bullet and just saying "no" is the best way to quit—but that doesn’t mean you shouldn’t consider getting some extra help.

Many people have success with low-nicotine patches. Just remember, it’s important to avoid smoking while using these patches. The prescription drug varenicline (Chantix) has been shown to reduce symptoms of nicotine withdrawal. Be aware that smoking cessation drugs can have serious side effects, so make sure you discuss the pros and cons with your physician.

Hypnotherapy is also worth exploring. Several small studies suggest it is as, if not more effective than nicotine replacement.

What About Electronic Cigarettes?

A position paper published in July 2020 by the European Association of Preventive Cardiology reported that the research on whether or not e-cigarettes actually help people quit smoking has had conflicting results.

Studies have also found that vaping raises heart rate and blood pressure, damages the endothelial lining of the blood vessels, and makes the arteries stiffer and less elastic. Plus, e-cigarettes have been linked with an increased risk of heart attacks, although to a lesser degree than regular cigarettes, as well as adverse effects on the lungs.

For these reasons and more, I do not recommend e-cigarettes for smoking cessation.

Ready, Set, Go!

Whatever method you decide on, start preparing to quit one week ahead of time. Here are a few tips to help you lay the groundwork:

  • Consider quitting during a break from your usual routine (vacation/weekend).
  • Remove all smoking-related items from your house, car, and office.
  • During your lead-up week, only smoke outside. Do not allow anyone to smoke in your house, car, or office.
  • Start a daily exercise program, whether it's walking, swimming, biking, or exercise videos.
  • Stock up on healthy munchies like celery and carrot sticks, fruit, sugarless gum, etc.
  • Tell everyone you know you are quitting.

The following will help you get through the first three days—the time it takes nicotine to leave your system—and any other difficult days that may come along:

  • Avoid locations and situations that triggered your smoking breaks.
  • Exercise!
  • Don’t stress about weight gain or use it as an excuse to start up again. You can work on that after you get over the hump.
  • Drink 10 glasses of water daily, with a slice of lemon or lime if desired.
  • Take the money you would have spent on cigarettes each day, toss it in a glass jar, and reward yourself for quitting. One of my patients realized her habit was costing $360 a month!
  • Commit to yourself and to a loved one to stop smoking and ask for help if you need it.
  • Keep your eye on the prize: better health, longevity—and a dramatic reduction in your risk of heart disease and cardiovascular death.
Dr. Stephen Sinatra

Meet Dr. Stephen Sinatra

A true pioneer, Dr. Sinatra spent more than 40 years in clinical practice, including serving as an attending physician and chief of cardiology at Manchester Memorial Hospital, then going on to formulate his advanced line of heart health supplements. His integrative approach to heart health has changed the lives of hundreds of thousands.

More About Dr. Stephen Sinatra