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Tobacco Use and Heart Disease: A Growing Global Health Challenge

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(Credit: Sucheta Das, Flickr.)

More than 1 billion people worldwide currently use tobacco products. While that may sound like a staggering number, tobacco use, particularly in the United States and Europe, is actually decreasing. But global health experts caution that this overall decline might be a bit of smoke and mirrors.

In many countries in Africa and Asia, tobacco use is increasing by 3.4 percent each year and with it comes a rise in all the health complications associated with smoking and tobacco use, such as heart disease, stroke, and cancer, among many others. These diseases, known collectively as non-communicable diseases (NCDs) are emerging as the next great global health threats, with cardiovascular disease as the leading cause of death among NCDs, killing 17.5 million people worldwide each year. In sub-Saharan Africa, heart disease is the second overall leading cause of death behind HIV/AIDS.

And tobacco use plays a huge role in the surge of heart disease in developing nations.

“The reason for this increase in tobacco use in these regions is a combination of factors – from tobacco companies targeting these countries for product sales, to countries producing their own tobacco products, to an increase in disposable income – that are causing cigarette use to rise,” said Helene Glassberg, MD, an associate professor of Medicine in Cardiology. “But the one thing that is consistent across all parts of the world is that tobacco use is directly linked to serious health risks.”

In fact, tobacco use is the leading cause of preventable deaths worldwide and can double or even potentially quadruple the risk of heart disease or stroke.

“The risks associated with smoking cannot be understated,” Glassberg said. “Many people continue to smoke despite knowing these risks, but in resource-limited settings, there is also a lack of education and information about the hazards of cigarettes that can cause more people to take up smoking in the first place.”

This is especially true among young people.

“Hardly anyone starts smoking after age 25,” Glassberg said. “Nine out of 10 smokers start by age 18 and 99 percent start before age 26. For young people, the long-term health risks from smoking seem far away, but in reality, there are short-term effects such as decreased physical fitness and respiratory health, faster resting heart rates, and nicotine addiction—which can lead to heart disease and other health conditions down the road that could have deadly consequences.”

One jarring example of smoking among young people was the recent CNN feature highlighting an Indonesian boy, Aldi Rizal, who gained notoriety when he became known as the “chain-smoking toddler” after a video of him at 2 years of age smoking cigarettes went viral.  

Indonesia is at the epicenter of the global tobacco-use crisis, where more than 267,000 children are estimated to use tobacco products every day. In 2013, more than 57 percent of men were reported to be smokers in Indonesia and more than 42 percent of teens ages 13 to 15 use it, according to the Tobacco Atlas, compared with 17 percent and 8.2 percent, respectively, in the United States. This high rate of tobacco use isfueled by lack of control over advertising, relaxed sales, and low prices.

But Indonesia is hardly alone in its high number of young people who smoke and thus are at risk for heart disease and other tobacco-related health complications. According to the U.S. Centers for Disease Control and Prevention (CDC), between 80,000 and 100,000 children worldwide start smoking every day—roughly half of whom live in Asia. Fifty percent of children who begin smoking in adolescent years continue to smoke for an average of 15 to 20 years.

However, efforts are underway to combat this growing epidemic. Over the past decade, WHO Global Ambassador for Non-communicable Diseases Mike Bloomberg and his foundation Bloomberg Philanthropies has invested nearly $1 billion to support policies that are proven to reduce tobacco use and protect people from its deadly effects. These policies fall into six categories: measuring tobacco use, protecting people from second-hand smoke, offering help to people who want to quit, warnings that alert people to health impacts and bans on tobacco ads, enforcing bans on tobacco advertising, marketing, and promotion, and raising taxes to reduce tobacco use, especially among kids.

And here at Penn Medicine, we are piloting new programs to help patients quit smoking and working on research to uncover the psychological elements of nicotine addiction, contributing to the global effort to end tobacco use worldwide.

“Quitting smoking before age 40 reduces the risk of dying from smoking-related disease by as much 90 percent and one year after quitting tobacco, the risk of heart disease is reduced by half as compared to smokers and after 15 years of quitting, the risk of heart disease is the same that of a non-smoker’s,” Glassberg said. “It may not seem easy to quit, but truly it can save your life!”

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