Lung cancer may get most of the headlines, but the destructive connection between smoking and heart disease is taking arguably an even bigger toll on public health in Kentucky, which has the highest smoking rate among adults in the U.S.

Tobacco smoke inhibits cardiovascular function in many ways – no organ is spared. It raises a person’s chances of developing clogged arteries, high blood pressure, heart attack, heart failure, stroke, and a myriad of other maladies. And inhaling secondhand smoke increases the risk of cardiovascular disease even more than it does cancer, a real problem in a state where many counties and towns lack smoke-free ordinances for public places and businesses.

Smoking rates in the U.S. have been on the decline for decades, but remain stubbornly high in Kentucky when compared to the country as a whole, and especially so in the eastern Kentucky counties that are part of Appalachia. In the commonwealth, public education efforts to curb smoking rates continue to gain momentum, as advocates from all walks of life – with a valuable contribution from cardiologists – spread the word about tobacco’s connection to heart disease.

As part of KET’s Smoking and Health Initiative, funded in part by the Foundation for a Healthy Kentucky, this article takes a closer look at the ways smoking harms the cardiovascular system and how quitting smoking can reverse much of the destructive impact.

How Smoking Affects Normal Cardiovascular Function

Dr. Patrick Withrow practiced cardiology in Paducah for over 30 years. He served as the chief medical officer at Baptist Health Paducah and is now the hospital’s director of outreach. He has seen the devastating impact of smoking firsthand. According to Withrow, tobacco affects the cardiovascular system in its entirety, starting with the lining of the blood vessels in the heart.

Chemicals in cigarettes cause the artery linings to become inflamed, and they also increase the production of blood platelets, which leads to clotting. In addition, the chemicals increase low-density-lipoprotein (LDL) cholesterol, the so-called “bad cholesterol.” All of these changes cause plaque to form in the arteries, and when this plaque develops in the arteries – called atherosclerosis – and forms a clot, the health crisis level is raised, quickly.

“As time goes on, you develop more and more of these things, and they rupture and dump the cholesterol, and this stuff is a pool of liquid, and basically this is called an atheroma,” says Withrow. “When it ruptures, it dumps the contents into the bloodstream, and it forms a big clot, and what used to be a 70 or 90 percent blockage is now suddenly 100 percent. And that’s an acute myocardial infarction.”

A myocardial infarction (heart attack) is only one of many medical conditions that arise from coronary artery disease and are intensified by agents in tobacco smoke. Others include:

• Hypertension (high blood pressure): Caused by constriction of the arteries due to atherosclerosis and the presence of nicotine as a stimulant. “Nicotine increases heart rate, blood pressure, and pulse pressure,” Withrow says, ”and every beat has just a kind of pounding on this atherosclerotic plaque.”
• Ischemic stroke: The formation of a clot in an artery that blocks blood flow to the brain. There are various types of strokes, and two related to atherosclerosis occur when either an artery in the brain becomes clogged with plaque, or a clot in a heart artery breaks free and travels north nearer to the brain, where it becomes lodged.
• Abdominal aortic aneurysm: Occurs when the abdominal aorta, which carries blood to the lower body, becomes blocked and ruptures. “Basically, it’s the same atherosclerotic process but with a much larger vessel,” Withrow says.
• Peripheral vascular disease: A loss of blood flow to the limbs, especially the lower limbs, due to clogged arteries.

“There is not one of these steps where cigarettes are not involved,” Withrow says. “All of the things you don’t want to happen – they happen when you smoke.”

Cardiovascular Dangers of Secondhand Smoke

“Secondary smoke – this is important – is just as bad as if you’re the smoker,” says Dr. Juan Villafane, a pediatric cardiologist in Louisville. “And it affects kids as well.”

Villafane and colleagues issued an American Heart Association scientific statement detailing the effects of secondhand smoke on the cardiovascular health of children last year.  It concluded that while sidestream smoke (smoke emitted from the burning end of a cigarette) does not contain as many toxic materials as mainstream smoke (exhaled from the smoker), the long-term effects of breathing in sidestream smoke may be just as damaging, especially with prolonged exposure.

For children living with secondhand smoke, the impact can be seen in multiple ways. According to the AMA report, secondhand smoke contributed to a number of harmful health conditions for newborns, including an increase in postnatal weight gain, which is a predictor of future childhood and adult obesity. The report also presented research showing that secondhand smoke exposure to children is associated with higher emergency room visits and increased rates of behavioral and cognitive problems. Children from minority groups and lower socioeconomic status are at increased risk of being exposed to secondhand smoke.

And there are a host of other problems associated with smoking while pregnant, which is another major public health problem in Kentucky. “There’s so many things that result from pregnant women smoking,” Withrow says. “Low birth weight, SIDS (sudden infant death syndrome), ear infections, bronchitis, even death of the kid and the mom, too.”

The negative effects of tobacco use during pregnancy was discussed extensively in a recent episode of KET’s Connections, hosted by Renee Shaw and with guest Dr. Kristin Ashford from the University of Kentucky College of Nursing.

Smoking’s Impact on Kentucky – Cardiologists Speak Out

Kentucky has the highest smoking rate among adults in the U.S. at nearly 26 percent as of 2015.  These high smoking rates contribute to heart disease mortality rates that, in some eastern counties, are 42 percent higher than the national average, as new research from the Appalachian Regional Commission shows.

“Now, you don’t have to smoke to have a heart attack, but it sure does help,” says Withrow.  “You can have the genetics for this. You can have some problems with too many clotting factors and a lot of different things, but for the most part, if you smoke, in all likelihood you’re going to have coronary artery disease.”

After years of treating unnecessary cardiovascular disease caused or complicated by smoking, both Withrow and Villafane are stepping out beyond their clinical roles and becoming public advocates for smoke-free ordinances and increased tobacco taxes – policy strategies proven to reduce smoking rates.

“If we increase the price of cigarettes, I think that would reduce youth smoking, which is wonderful,” Withrow says. “I hope it would reduce rates among pregnant women, too… that’s the most important reversible thing.” Kentucky’s current 60-cent tax on a pack of cigarettes ranks 43^rd in the U.S.

The Reversal Effects of Quitting

The benefits to heart health from quitting smoking are substantial, and many come quickly. According to the Centers for Disease Control, a person’s risk of having a heart attack drops dramatically one year after quitting. Within five years, the risk of having a stroke is decreased to nearly the same risk for a lifelong non-smoker. (The buildup of atherosclerotic plaque caused by smoking cannot be reversed simply by quitting, however.)

It bears repeating that overall, smoking rates have declined significantly in the U.S. over the past 50 years, and in Kentucky as well. This shows that efforts by the medical community and public health advocates to educate their fellow Kentuckians about the dangers of tobacco use are working.

Resources are available for those seeking to quit smoking. Kentucky’s Quit Line is 1-800-QUIT-NOW and the program can also be accessed online.

This KET article is part of the 2017 Smoking and Health Initiative, funded in part by the Foundation for a Healthy Kentucky.