Smoking

Know

How Smoking Affects Your Cardiovascular HealthCigarette break

Smoking affects your health in a big way. The many harmful chemicals in cigarettes cause damage to nearly every organ in your body, including your heart, blood vessels, mouth, eyes, lungs, bones, reproductive organs, bladder, and digestive organs. This is why smoking causes so many deaths — more than 37,000 Canadians will die prematurely each year from tobacco use and almost 6,300 non-smokers will die from exposure to second-hand smoke.

The nicotine in smoke causes the arteries of your heart to narrow. The carbon monoxide released from cigarettes damages the walls of your arteries, encouraging fat to build up on artery walls.

Smoking also:

  • Raises your LDL (lousy) cholesterol
  • Lowers your HDL (healthy) cholesterol
  • Speeds up your heart rate
  • Raises your blood pressure
  • Makes your heart work harder

Any amount of smoking — light, occasional, or second-hand — is dangerous and likely to cause damage to your cardiovascular system. The harmful chemicals from a cigarette can negatively affect the condition and functioning of your heart and blood vessels. For example, nicotine increases your heart rate, while carbon monoxide (a toxic gas) replaces oxygen in your red blood cells. Together, these affect the normal function of your heart, eventually making it work harder. Over time, smoking also causes plaque to build up in your arteries, a decrease in the oxygen in your blood, and increased blood pressure.1, 4 What you face as a smoker if you continue to smoke includes the following:

  • On average, smokers live 10 fewer years than non-smokers.
  • Smokers have double the risk for cardiovascular disease compared to non-smokers.
  • Smokers are up to four times more likely to experience sudden cardiac death than non-smokers.1

Benefits of Quitting Smoking

Quitting smoking is the most important thing you can do to positively affect your heart health. Becoming smoke-free at any age improves your health and can extend your life. It’s never too late to quit, but the sooner you quit, the sooner your body can begin to heal and repair the damage caused by smoking. The following are just a few of the many positive statistics associated with quitting the habit:

  • The benefits of quitting begin within 20 minutes of your last cigarette, and at one year, your risk for a heart attack is reduced by 50%.
  • Fifteen years after you quit, you are at no greater risk for death than a non-smoker.4
  • Quitting smoking lowers your risk for hospitalization and death.
  • More than 6.6 million Canadians have successfully quit smoking.3
  • Smoking is the most preventable cause of cardiovascular disease.
  • No matter how long you have smoked, quitting will greatly improve your health.

Quitting smoking is difficult. On average, most smokers try to quit five to seven times before finally succeeding.5 A variety of proven techniques are available to help you stop.

Successful quitting requires making a continual effort and getting plenty of help through a combination of counselling and medications that specifically target quitting. But putting in the effort can return your health to that of a non-smoker within a few years, offering you a longer, healthier life.

Within just 24-hours of quitting, your blood pressure and pulse rate may drop. When you quit smoking, you’ll breathe easier and enjoy physical activity a lot more. Also, your food will taste better, you’ll smell fresher, and you’ll save money.

Prevalence

People begin to smoke and continue to smoke for many different reasons. If you smoke, you are strongly influenced by physical, environmental, social, and psychological factors. Quitting isn’t easy, but stopping smoking will positively affect your health like no other single factor. Nearly 5 million Canadians could significantly improve their health by quitting smoking.1

Smoking Trends in Canada

Smoking in Canada has dropped by more than 60% in the past 50 years. Currently, fewer than one in five Canadians smokes.2

Trends by Gender
Men are still more likely to smoke than women. Currently, 19.7% (2.7 million) of smokers are male and 13.8% (2 million) are female.2

Current Smoking Prevalence: Distribution by Age in Canada
Smoking is least common among people ages 15 to 19 and those older than age 55.2

Smoking in Ontario
Since 1999, Ontario has been one of the few provinces with smoking rates below the national average.2

Understand

Smoking is not a Habit, It's an Addiction

Quitting smoking is hard, but it’s not impossible. Every year, thousands of people go smoke-free. Quitting smoking is the most powerful thing you can do to reduce your risk for heart disease. Because smoking is so highly addictive, quitting is extremely difficult and requires persistent effort and help from others.

The decision to quit smoking is influenced by your beliefs about the benefits of quitting and by the physical dependence of smoking. Many smokers attempt to quit several times before succeeding. When you are ready to quit, a variety of proven methods are available to increase your chances.

Your quit plan should include a range of strategies to address the various aspects of smoking. Smoking is an addictive process that becomes a learned behaviour, and it is supported in three ways:

  1. Physical Dependence
    Nicotine is a powerfully addictive drug. Once inhaled through cigarette smoke, nicotine is rapidly absorbed into your bloodstream. Your body quickly learns to crave its presence. When you stop smoking, the amount of nicotine in your body drops and you may experience irritability, difficulty sleeping, changes in appetite, and fatigue. Reactions vary from person to person. These are normal signs of recovery from nicotine.
  2. Behavioural Conditioning
    Smoking behaviours are repetitive and, over time, can become unconscious habits reinforced by where you smoke, the activities you engage in while smoking, and the emotions you feel when you have a cigarette. Behaviours that are repeated hundreds of thousands of times each year add to the difficulty of quitting.
  3. Social Aspects
    Many people smoke in the company of friends and family. The social aspects of nicotine dependence are difficult to overcome. This is because once you quit, you are still exposed to the social situations that remind you of smoking. Nevertheless, you can learn to handle social situations so that they are not triggers for smoking.

Physical Dependence

Inside a Cigarette

To better understand why smoking is so bad for your health, it helps to know what’s in a cigarette. The three main components of a cigarette are nicotine, tar, and carbon monoxide. Each cigarette contains tobacco and numerous chemicals, including toxic substances. Tobacco naturally contains nicotine, notorious for its highly addictive properties. In addition to nicotine, smokers and those around them are exposed to more than 4,000 chemicals. Hundreds of these are toxic and more than 50 can cause cancer.4

  • Butane found in lighter fluid
  • Cadmium found in batteries
  • Stearic acid found in candle wax
  • Toluene found in industrial solvent
  • Nicotine found in insecticide
  • Ammonia found in toilet cleaner
  • Methanol found in rocket fuel
  • Methane found in sewer gas
  • Acetic acid found in vinegar
  • Carbon monoxide
  • Arsenic found in poison
  • Paint
  • Fuel

Nicotine Dependence

Nicotine is why it’s so hard to quit smoking. Found naturally in tobacco, it is a highly addictive drug that is absorbed in no more than four to seven seconds through the tissue that lines your nose and mouth. In this way, nicotine is fast-tracked to the addiction centre of the brain.

Nicotine alters your brain chemistry, changing the way you feel and act. It can make you alert and better able to concentrate because it releases the chemical dopamine in the brain. Dopamine also has the effect of increasing feelings of pleasure so that you associate smoking with positive sensations. Dopamine therefore strongly rewards smoking behaviour, making it highly likely you’ll continue smoking. Once you experience nicotine, as with other addictive substances, your body craves more of the drug. As your tolerance increases, you need to smoke more to avoid nicotine withdrawal symptoms.

It’s important to recognize that nicotine acts both physically and psychologically. The powerful physical addiction is created as nicotine rewards smoking behaviour by altering the brain, and the speed at which nicotine reaches the brain creates a strong association between smoking and the feelings it generates. Together, these mechanisms create a negative cycle that is extremely difficult to break.6

This video lecture explains the process of nicotine addiction (Mayo Clinic).

Health Risks

Smoking is associated with many health risks for both the smoker and those exposed to the second-hand smoke, causing significant damage to the entire body. Although no level of smoking is considered safe, smoking fewer cigarettes for a shorter period of time can reduce the damage. Any level of smoking can cause the following:

Short-term risks:

  • Shortness of breath
  • Worsening of asthma symptoms
  • Respiratory infection
  • Harm to pregnancy
  • Infertility
  • Impotence

Long-term risks:

  • Lung cancer
  • Cancers of the colon, mouth, throat, bladder, and cervix
  • Emphysema and bronchitis
  • Smoker’s cough
  • Heart disease and stroke
  • Complications during pregnancy that can lead to an underweight baby or premature death in infancy
  • Osteoporosis
  • Digestive problems
  • Compromised immune system — increased likelihood of flu and pneumonia
  • Decreased vitamin C levels, causing wounds to heal more slowly
  • Restricted circulation in the legs
  • Macular degeneration (vision loss at the centre of the field of vision)
  • Psoriasis
  • Gum disease
  • Tooth loss
  • Raynaud’s phenomenon (fingers that turn white or blue in the cold)6 7

Dangers of Second-Hand Smoke

Second-hand smoke is the smoke from a tobacco product exhaled into the environment. It contains not only asbestos, arsenic, ammonia, and benzene but more carbon monoxide and tar than the smoke that is inhaled by the smoker. Because the harmful chemicals remain in the air long after the cigarette is smoked, non-smokers frequently in contact with second-hand smoke experience excessive coughing and are at risk of developing heart disease, lung cancer, emphysema, and chest infections — putting them at increased risk for premature death.

The smoke exhaled by the smoker tends to be more toxic than the smoke burning directly from the end of the cigarette. Therefore, those exposed to second-hand smoke are essentially inhaling the same chemicals as the smoker but with an increased sensitivity that comes with being a non-smoker.

Diagnosis

Addiction Questionnaire: How Addicted to Nicotine Are You?

Quit Medications

There is a variety of medications available to help you quit smoking:

  How It Works Cost per Unit Cost of 12-Week Therapy Possible Side Effects
NRT Patch Nicotine replacement therapy (NRT) helps reduce withdrawal symptoms, such as cravings, anxiety, irritability, headaches, and difficulty concentrating. Each form of NRT can be used alone or with others. The type, amount, and length of NRT treatment can be changed to meet your needs. $25-30 $360
  • Headache
  • Trouble sleeping
  • Dizziness
  • Nausea
  • Skin irritation
  • Stomach upset
NRT Inhaler $40 $420-840
  • Headache
  • Mouth/throat irritation
  • Nausea
NRT Gum $32-42 $42-56
  • Mouth soreness
  • Jaw pain
  • Hiccups
  • Nausea
  • Clings to dental work
NRT Lozenge $32-42 $42-56
  • Nausea
  • Heartburn
  • Hiccups
  • Headache
  • Coughing
NRT Mouth Spray    
  • Headache
  • Nausea
  • Vomiting
  • Changes to taste
  • Tingling sensation in the mouth
Varenicline (Champix) Varenicline (Champix) Varenicline comes in pill form. It targets the nicotine receptors in your brain, reducing your cravings for nicotine and taking away the satisfaction you get from smoking. Varenicline should be started 8 to 35 days before your quit date. $72 $432
  • Nausea
  • Trouble sleeping
  • Headache
  • Abnormal dreams
  • Constipation
  • Vomiting
  • Gas
  • Altered/depressed mood
  • Allergic reaction (rare)
Bupropion (Zyban) Bupropion is taken in pill form. It helps balance the chemicals in your brain to reduce nicotine cravings and withdrawal. Bupropion should be started at least 7 days before your quit date. $63-90 $175-252
  • Difficulty sleeping
  • Dry mouth
  • Nausea
  • Constipation
  • Anxiety
  • Altered taste
  • Palpitations
  • Shakiness
  • Seizures (rare)

Don’t let the cost of quit-smoking medications keep you from using them. It’s important to remember that these medications are proven to double or triple your odds of successfully quitting. Most quit-smoking medications are far less than what you’ll ultimately pay if you continue to smoke.

Consider this: The cost of smoking one pack of cigarettes is about $10 per day, $70 per week, or $3,920 per year. Think of the money you will save over the long term once you quit.

Act

Quit Medications

Quitting smoking is a complex process that requires preparation.

When you begin to think about quitting, and you weigh the benefits against the drawbacks, you’ll likely proceed through roughly five stages:

  • Stage 1 — Not Yet Ready
    At this stage, you may have no intention of quitting. But you can begin to gain valuable information and seek nonjudgmental support. Part of this early process involves understanding why you smoke, how it affects your health, and what you can expect when you finally quit.
    Stage 2 — Considering the Quit Process
  • You will begin to identify your concerns about quitting and plan appropriate strategies to overcome the challenges of giving up smoking. By targeting potential solutions, you are likely to strengthen your resolve to quit.
  • Stage 3 — Preparing to Quit
    This is the stage at which you begin to understand your reasons for smoking and to pinpoint the combination of quit methods that will work best for you throughout the process. In addition, you will select a quit date and begin to develop the necessary coping strategies that will help you succeed.
  • Stage 4 — Quitting Smoking
    You will create a specific plan that will carry you through the quit process. A range of coping strategies (medications, behavioural and social reconditioning) will help you tackle the nicotine withdrawal that’s at the centre of smoking addiction.
  • Stage 5 — Remaining Smoke-Free
    The challenge continues as you incorporate strategies to remain smoke-free. Throughout the quit process, you will seek support and advice to help you change your behaviour, control your surroundings, reducing stress, and recover from the inevitable slip-ups.

Quit Smoking Plan

Prepare two to three weeks prior to your quit date:

  • Make your car and home smoke-free.
  • Identify routines that trigger your smoking (morning coffee, work breaks, after-dinner tea). Consider keeping a smoking log that allows you to track when you are smoking, who you are with, and how you feel before and after you smoke. Do you notice a pattern? What emotions do you associate with smoking? Start making an effort to change these routines.
  • Review triggers and dangerous situations that increase the likelihood of relapse (alcohol, other smokers, acutely stressful situations — such as the loss of a loved one, arguments with your partner or family, pressure at work, the holidays). Make a plan that will permit you to overcome these obstacles.

One week prior to your quit date:

  • Cut back on the amount you smoke: Consider using nicotine gum or an inhaler as an aid to accomplish this.
  • Put STAR into action:
    • Set the date
    • Tell family and friends about your upcoming quit date and enlist their support
    • Anticipate challenges
    • Remove tobacco products from your environment
  • Recognize triggers, or the situations, times of day, and even foodsthat tempt you to smoke.
  • Name the top three reasons why you want to quit and post them on your fridge.
  • Plan different rewards for staying smoke-free.
  • If you’re using Champix or Zyban, begin taking your medication eight days prior to your quit date.
  • Address concerns about withdrawal symptoms (urge to smoke, anger, frustration, anxiety, increased appetite, restlessness, difficulty concentrating, headaches).
  • Cravings or urges to smoke last only three to five minutes and are a normal part of the quit process. Use strategies to dampen your cravings:
    • Take medication (NRT, for example) to relieve symptoms and distract yourself.
    • Review the four D’s (Drink water, Distract, Delay, take Deep breaths).
  • Use relapse as an opportunity to learn more about your smoking behaviour. Most slip-ups occur in social or stressful situations, especially if alcohol is involved. Apply coping mechanisms:
    • Change the situation — ( leave the room and throw out your cigarettes)
    • Ask for help — talk to a counsellor or friend.
    • Talk positively to yourself — remind yourself of how far you’ve come.
    • Take action — engage in physical activity or chew gum.

On your quit date:

  • If you’re using one, apply your nicotine patch first thing in the morning.
  • Until you feel ready, make a conscious effort to avoid people who smoke.
  • Make sure all cigarettes are removed from your home, car, and workplace.
  • Keep busy at times when you might normally smoke.
  • Remember that cravings last 3 to 5 minutes,and use the four D’s. Seek out strategies to cope with smoking urges (brush your teeth after meals, go for short walks at break times, do crossword puzzles, knit, listen to music, meditate, call a friend, take a shower, check email).
  • Use a nicotine inhaler or nicotine gum to help you through cravings (but not if you are taking Champix).
  • Carry things to put in your mouth, like sugarless candies, gum, toothpicks, or a straw.
  • Strive for abstinence.

Help in Quitting:

Establish reasons for smoking “Why Test” 

Dr. Mike Evans “What is the Single Best Thing You Can Do to Quit Smoking”

Testimonials: World’s Biggest Break Up with Smoking – Break it Off 

Incentives

Beyond the many health benefits that begin within as little as 20 minutes of quitting smoking, you’ll experience other advantages, such as:

  • Your food will taste better.
  • You’ll save money.
  • You’ll feel better about yourself and have a greater sense of self-control.
  • Your home, car, and clothing will smell better.
  • As a non-smoker, you’ll serve as a role model for your children, decreasing the likelihood that they will smoke.
  • You’ll no longer expose your family and friends to second-hand smoke.
  • You’ll perform better during physical activity.
  • With fewer wrinkles and whiter teeth, you’ll look better.7

How much do you spend on cigarettes?

Government of Canada – Cost Calculator

Quit Process

What to Expect

Knowing what to expect when you quit smoking can reduce stress and give you a better chance at success.

Withdrawal Symptoms

It’s normal to experience withdrawal symptoms when quitting smoking. Symptoms may include headache, dizziness, mild confusion, anxiety or restlessness, difficulty concentrating, and changes in your mood. Medications that aid in quitting will help reduce or eliminate these withdrawal symptoms. Withdrawal symptoms typically begin on the first day of quitting and dissipate around the fourth week.

As your body gets less nicotine, you will feel more and more uncomfortable. This discomfort will peak after two to three days, signaling that your body is beginning to heal from the damage of smoking. Over time, your brain will adapt to the reduced nicotine and many of your withdrawal symptoms will subside. Keep in mind that your discomfort is only temporary. The benefits of quitting last a lifetime.

Cravings

Cravings are common. Their intensity usually decreases over two to three weeks. Remember that a craving normally last only three to five minutes. Try to keep yourself occupied for that time and the craving should pass.

The good news is that each new day without a cigarette will be easier and your cravings and withdrawal symptoms will decrease.

Dealing with Stress

Stress is a normal part of life. Many people smoke because they believe it helps them cope with stress. Actually, smoking can increase stress because nicotine causes your heart rate and blood pressure to rise. You may want to join a support group or find a friend to quit with or talk to. Learn to relax, and when you feel stress coming on, take deep breaths through your nose.

Changes to Your Mood

As your body adapts to being a non-smoker, you may feel anxious, irritable, depressed, or have difficulty concentrating. Be patient with yourself in the first few weeks after quitting. If you’re taking a quitting aid and your family notices that you are agitated, in a depressed mood, or that your behaviour is changing in unusual ways, stop taking the medication and contact your follow-up support or family doctor immediately. Do the same if you have an allergic reaction.

Coughing

Many smokers find that they cough more in the first few weeks after quitting. This means your lungs are clearing. Consider it a sign that you are getting healthier.

Managing Body Weight

Experiencing an increase in appetite is normal while quitting smoking. Some people can gain 5 to 7 pounds during the first few months of quitting. Making a small change to your diet (choosing healthy snacks and drinking plenty of water) and exercise routine (going for a 30 minute walk) can help manage your appetite and keep your weight in check.

Effects of Caffeine

Cut back your intake of caffeine by at least half, either by reducing the number of cups of coffee, tea, or colas that you drink each day or by switching to decaffeinated beverages. Non-smokers are more affected by caffeine and reducing your intake will help you avoid any unpleasant effects, such as “caffeine jitters,” nervousness, irritability, headaches, sleeplessness, or heart palpitations.

Recognizing Your Smoking Triggers

Smokers tend to develop a set of conditioned responses to smoking. These are often referred to as “triggers” because they reinforce the habit of smoking and strengthen the addiction. Before attempting to quit, it’s important that you learn to recognize your own smoking triggers and then find strategies to avoid them. Pinpoint your triggers in advance of your quit date by taking note of the following:

  • The times of day in which you smoke
  • What you’re feeling when you light up
  • The strength of your desire to smoke (mild, medium, strong, intense)
  • Where you are and what you’re doing when you smoke
  • Who is with you when you smoke

Once you recognize your triggers, appropriate coping strategies can be used to aid in changing your behaviours. Identify your own personal triggers to devise effective coping strategies and avoid tempting situations.6

Relapse Prevention

Have a plan to get back on track before you relapse. If you find yourself smoking, do the following:

  • Change Your Situation
    Stop smoking immediately, leave the room, throw out your cigarettes, and carry on with your quit attempt.
  • Talk Positively to Yourself
    Remind yourself of how far you have come and encourage yourself to keep at it.
  • Take Action
    Find something else to do that makes it difficult to smoke, such as showering, engaging in physical activity, or chewing gum.
  • Ask for Help
    Talk to someone to distract or encourage you.

Don’t let a slip throw you off your quit-smoking plan.

Resources

Community Programs

The University of Ottawa Heart Institute’s Quit Smoking Program is available to all smokers who are interested in quitting. We use proven techniques and individualized counselling to help people kick the habit. To register for the Quit Smoking Program, please call 613-761-5464.

There are other options for quitting smoking in our region. It is up to you to decide which option is best for you. Smoking cessation resources are available from the Canadian Cardiovascular Pharmacist Network.

Keep in mind this one important tip: Most people find that the more support they get while trying to quit, the better!

UOHI Resources

Print Resources

  • One Step at a time Series (Canadian Cancer Society)
    For smokers who want to quit (English/French)
    For smokers who don’t want to quit (English/French)
    If you want to help a smoker quit (English/French)
  • On the Road to Quitting: Guide to becoming a non-smoker
    This guide will help individuals prepare and take action to successfully stop smoking.
  • Smoking Diary
    A tool for tracking ongoing smoking when patients/clients are attempting to reduce or quit smoking. The tool is intended to enhance patients' awareness of their smoking behaviour.

Mobile Applications

Websites

 

To view more community resources near you, click here.

REFERENCES

1. Health Canada.

2. Reid JL, Hammond D, Burkhalter R, et al. Tobacco Use in Canada: Patterns and Trends, 2012 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.

3. Canadian Cancer Society.

4. Heart and Stroke Foundation.

5. Quit Smoking Canada.

6. Centre for Addiction and Mental Health.

7. Treating Tobacco Use and Dependence: 2008 Update — Clinical Practice Guidelines.

8. The NY State Department of Health Tobacco Control Program