Overview. There is no doubt whatsoever that people who smoke have a higher frequency of heart disease, develop it at a younger age and die approximately 10 years sooner than nonsmokers. Smokers, on average, die of heart disease in their early 50's whereas the nonsmokers commonly dies in their early to mid 60's. As a general rule, the smoker is at double the risk of heart disease, at any given age, compared to the nonsmoker. Furthermore, if the smoker ceases to smoke, the risk of developing heart disease drops very quickly, within months, to that of the nonsmoker. For example, if a person has smoked for 20 years it does not require 20 years to return to the nonsmoker level of risk. Therefore, to stop smoking is very beneficial no matter when you stop because the benefits accrue very quickly. In other words, it is never too late to stop smoking. Too many people think to themselves, I've smoked for 50+ years and the damage has been done and it won't do me any good to stop now." How wrong they are. 

Proof. A great deal of discussion centers around the fact that we (doctors) do not know the exact compound or element in tobacco that causes heart disease and thus we have not actually "proven" that smoking is the cause of heart attacks. This is the argument of those persons who wish to continue smoking. My response to that argument is that we do not need to know exactly which compound is responsible because we know, whatever it is, that it is directly related to smoking because the heart attack rate drops dramatically when smoking is stopped. What else do we need to know to properly advise the patient in this matter? The doctor is on very firm ground, scientifically, in recommending the patient stop smoking as a benefit to health. After all, that is what the doctor is being paid to do, tell people how to maintain health, prevent illness and treat illness when it develops. The old adage, "An ounce of prevention is worth a pound of cure" is never more correct than when it is applied to smoking and health.

Prohibition. Many smokers see a parallel between anti-smoking laws and the laws surrounding the prohibition of alcohol in the 30's. A moment's reflection will show that these are two different problems. First, we have no laws against people smoking. Regulations about where you can smoke, yes, but not about smoking itself. Second, smoking, in contrast to alcohol, is a public health problem because breathing second hand smoke is as bad as smoking in so far as health is concerned. It is important to distinguish "Public Health" from "Individual Health." Public health is concerned with preserving the health of the entire population, not individuals, and endeavors to limit the spread of disease, particularly contagious diseases, by providing for clean water, clean air, sewage disposal, and other matters for the public good. Third, the health hazards of excess alcohol are related, in great measure, to the effects of alcohol on the liver, but smoking affects every organ in the body. Smoking is quite different than alcohol and presents an entirely separate set of problems.

Premature Aging. Premature heart disease is defined as heart disease occurring before age 50, reflecting acceleration of the heart disease process. Suffice it to say that smoking accelerates the aging process and all the diseases are associated with aging including heart disease, cancer and stroke. I have an article in my files devoted entirely to the topic of face wrinkles in smokers, showing how smoking is associated with premature (aging) wrinkling. We all get old fast enough so we don't need to do things that accelerate aging and leads to the "wreck of old age" whatever disease conditions that includes.

Stop Smoking. Encouraging and succeeding in getting the patient to stop smoking is a challenge of the greatest proportions. The patient may intellectually recognize the dangers and problems with smoking and want to stop, but is unable to do so for many reasons. We believe, in many cases, this is due to nicotine addiction, adding yet another problem to overcome. The use of nicotine patches in the effort to stop smoking may be of help to some but not all patients. There is no easy solution. Eventually the smoker has to take responsibility for his/her own health and bite the bullet. I have found the most successful patients have been those who have just decided that they don't want to smoke anymore and quit cold turkey. I wish we had an effective, sure-fire, method or treatment to help the patient stop smoking, but unfortunately none is available. Do whatever it takes, but stop.