Smoking And Your Heart

Mixed-race young woman smoking a cigarette
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Smoking tobacco is the strongest risk factor for developing heart disease.

In fact, the risk of having a heart attack is six times higher in smokers -- both men and women -- than in people who never smoked. World-wide, smoking is thought to account for almost 40% of first heart attacks.

Not only does smoking cause heart disease, but once you develop heart disease, continuing to smoke makes it much worse, much faster.

People who keep smoking after a heart attack have a much higher risk of subsequent heart attacks. People who smoke after bypass surgery or stenting have a much higher incidence of developing occlusion of the bypassed or stented artery. Smokers with coronary artery disease (CAD) or heart failure have a substantially higher risk of premature death than non-smokers with these conditions.

How Does Smoking Cause Heart Disease?

Smoking tobacco greatly accelerates atherosclerosis, the disease process that produces CAD, heart failure, peripheral vascular disease, stroke, abdominal aortic aneurysms, and sudden death.

Smoking accelerates atherosclerosis in several ways:

  • Smoking increases LDL cholesterol (bad cholesterol) levels, and reduces HDL cholesterol (good cholesterol).
  • Tobacco products contain chemicals that can irritate the blood vessel walls, increasing inflammation, damaging and "stiffening" the vessel walls -- all conditions that are associated with atherosclerosis.
  • Smoking increases adrenaline levels, which raises the blood pressure and cardiac stress, causing constriction of blood vessels.
  • Smoking abnormally increases the tendency of blood to form clots within blood vessels, thus increasing the risk of acute coronary syndrome (ACS).

In addition to accelerating atherosclerosis, smoking tobacco has other deleterious effects on the cardiovascular system.

The nicotine in tobacco contributes to the increase in heart rate and blood pressure seen after smoking a cigarette.

The Acute Effects Of Smoking A Cigarette

Several of the deleterious effects that are produced by smoking are relatively acute. Changes in the heart rate and blood pressure, the negative clotting effects, and even some of the chemical changes within the blood vessels can occur immediately when you light up.

The Cardiac Benefits Of Smoking Cessation

Just as smoking tobacco accelerates atherosclerosis, if you quit smoking you can slow the progression of atherosclerosis. Furthermore, smoking cessation actually substantially improves the overall function of your blood vessels. The risk of developing cardiovascular disease drops quickly after you quit smoking, and continues dropping the longer you remain tobacco-free.

After an episode of ACS, smokers who quit immediately have a much lower risk of dying in the near future, as compared to smokers who do not quit. Quitting also substantially reduces your risk of having a further episode of ACS.

Your risk of stroke also becomes substantially reduced over time after you quit smoking.

The benefits of smoking cessation are seen in both men and women in all age groups.

Why You Should Quit Right Now

Many of the adverse affects of smoking occur acutely -- right after you light up. This means that your chances of having an acute heart attack will actually diminish within 24 - 48 hours after your last smoke.

So not only should you quit smoking, you should quit smoking as soon as you possibly can.


Ambrose, JA, Barua, RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004; 43:1731.

Ockene, IS, Miller, NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation 1997; 96:3243.

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