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Why Vascular Surgeons Hate Smoking

An Interview with Dr. Allen D. Hamdan

ash trayNo smoker can deny knowing that cigarettes are hazardous to health. The risks of smoking have been public knowledge since 1965, when federal law required that all cigarette packs be labeled with the U.S. Surgeon General's warning about the connection between smoking and lung cancer.

What many people don't realize is that damage from smoking extends far beyond breathing problems and cancer.

Smoking is the single most powerful risk factor for vascular disease, and people who smoke put themselves at risk, according to the Society for Vascular Surgery.

To view smoking from a vascular surgeon's point of view on vascular damage and risks, Heartmail spoke with Allen D. Hamdan MD, FACS, and Clinical Director of Vascular and Endovascular Surgery at BIDMC.

Why do vascular surgeons hate smoking?

Allen D. Hamdan, MD, FACSThe minute you start smoking, you begin to damage cells that line the coronary arteries or other blood vessels. This layer of cells, called the endothelium, plays a major role in arterial disease. Chemicals in cigarettes deteriorate or injure this cell lining, which causes fatty material, called "plaque," to lodge in artery walls, causing atherosclerosis.

As a result of atherosclerosis, the normally flexible arteries can become stiff and narrow and that's when trouble can occur. Blood clots can form or the plaque can rupture, causing heart attacks, strokes and sadly, in some cases, death.

This restriction of blood flow can also lead to peripheral artery disease, which can make walking more difficult and, in advanced cases, can cause ulcers or gangrene in the feet - or even amputation.

The truth is that we see many individuals giving up cigarettes after they've experienced severe issues such as these. I'd like to see more people give up the habit before their health begins to suffer.

Since atherosclerosis can occur in non-smokers, how does smoking affect someone who already has "hardening of the arteries?"

Smoking compounds the risk. In fact, smoking makes the blood more likely to thicken and clot and can also cause plaque to burst. Smoking can also trigger coronary spasms in narrowed blood vessels in the heart, which can cause chest pain or a heart attack. To add to the damage, smoking can raise blood pressure and LDL (bad) cholesterol levels, while lowering HDL (good) cholesterol levels.

What about those who have diabetes and smoke?

If you have diabetes, the incentive to quit smoking is even more powerful. Diabetes is a disease that stops or impairs the ability of the pancreas to create insulin, which allows the body to move sugar into muscle, fat and liver cells, where it is used as fuel.

Smoking can make diabetes much more difficult to manage if you are already diabetic. Smoking cigarettes increases blood sugar levels while decreasing the ability to use insulin.

Smokers with diabetes are much more likely to have problems with circulation and difficulty with the healing of wounds. This can result in infections to feet and legs, which can sometimes require amputation. Diabetics who smoke also have a greater risk for developing permanent loss of vision, nerve damage, kidney disease, heart attacks, stroke and death.

What are long-range results of people with vascular and heart disease or diabetes who ignore the warning and continue to smoke?

Since smoking damages blood vessels all through the body, smokers may experience more severe vascular disease at an earlier age. For those who require surgery, the risk is even greater. Smokers who undergo surgery have a higher risk of post-operative infections, complications, trouble with wound healing and even death.

What about people who have smoked for years without problems?

If you're lucky enough to have escaped obvious signs of cardiovascular disease, you're still running high risks for future health issues. The vascular damage builds and increases over time. Smoking is the most preventable cause of premature death in the United States. Each day that you continue to smoke raises your chance of becoming a statistic.

What is your advice for smokers who want to give up the habit?

Quitting is always worthwhile, even after years of heavy smoking. There's a great deal of evidence that you can begin to see the benefits of quitting in as rapidly as two months. Blood pressure drops, oxygen levels in the blood rise, circulation begins to improve and overall energy increases. After a year, you've cut your risk of heart disease in half. It's important to consider smoking as you would any medical condition or disease - this is a condition that deserves treatment that can include counseling, medications and hypnosis - and quitting is often done most successfully in consultation with a physician. Your health insurance and Medicare may cover certain treatments for smoking cessation, so it's worthwhile to investigate your options.

Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted December 2011

Contact Information

CardioVascular Institute at
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215