You already know smoking is bad for you. But did you know that cigarette smokers face twice the risk of heart disease of non-smokers? In fact, smoking is the single most important habit that increases your risk for heart attack or stroke. 

Quitting smoking is hard, but not impossible – and it’s well worth the effort. Every year, thousands of people go smoke-free and enjoy the boost to their health and quality of life almost immediately. 

By quitting smoking, you can lower your blood pressure and pulse rate within a day. Soon you’ll breathe easier, enjoy physical activity a lot more and save money. More importantly, you’ll cut your risk of heart disease in half within a year. 

The challenge is how to quit. We’ve gathered resources to help you understand the addictive nature of smoking and what it does to your heart, along with practical advice to help you join more than 7 million other Canadians who have kicked the habit.¹

Why is smoking so addictive?

The three main components of a cigarette are nicotine, tar, and carbon monoxide, along with over 4000 chemicals and toxic substances, more than 70 of which can cause cancer.²

Nicotine is why it’s so hard to quit smoking. Found naturally in tobacco, it 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. 

 Once you experience nicotine, your body craves more of it. As your tolerance increases, you need to smoke more to avoid nicotine withdrawal symptoms. Nicotine acts both physically and psychologically to create a cycle of addiction that is extremely difficult to break.³ 

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. 

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. 

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. 

Why Is Smoking Bad for My Heart?

Nicotine causes the arteries of your heart to narrow and increases your heart rate. The carbon monoxide released from cigarettes replaces oxygen in your red blood cells. Together, these affect the normal function of your heart, eventually forcing it to work harder. 

Carbon monoxide also damages the walls of your arteries, encouraging fat to build up on artery walls.⁴ Over time, smoking also causes plaque to build up in your arteries, a decrease in the oxygen in your blood, and increased blood pressure.⁴  

Smoking causes many of the key factors that lead to cardiovascular disease: 

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

As a result, people who smoke on average live 10 fewer years than non-smokers. People who smoke are also up to four times more likely to experience sudden cardiac death than non-smokers.⁴

Second-hand smoke is the smoke from a tobacco product exhaled into the environment. It contains not only asbestos, arsenic, ammonia and benzene. More carbon monoxide and tar than smoke is inhaled by the person smoking. Because the harmful chemicals remain in the air long after the cigarette is smoked, people who do not smoke 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.⁴ 

The good news: after quitting smoking the risk of heart disease decreases. Being smoke-free within one year reduces the risk of a heart attack in half and by 15 years the risk of dying from a heart attack is the same as a person who never smoked.⁵  

How Can I Stop Smoking?

Because smoking is so highly addictive, quitting is extremely difficult. On average, most smokers attempt to quit several times before finally succeeding.  

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

What To Expect When You Quit

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

You’ll notice your body undergoing big changes as soon as you quit. Here’s a guide to some of what you might experience along with tips for adapting your behaviour so you can ride out any possible early discomfort. 

Withdrawal Symptoms

It’s normal to experience withdrawal symptoms when quitting smoking. Symptoms may include headaches, dizziness, mild confusion, anxiety or restlessness, difficulty concentrating, and changes in your mood. Medication that aids 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 lasts 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 smoke-free, 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 healthcare provider immediately.  

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 eating patterns (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. People who do not smoke 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. 

Quitting Process

Start by making your own plan for quitting or reducing to quit, including creating a support network and getting professional advice before you begin. Preparing a roadmap for quitting will help you overcome obstacles and cravings as they pop up. 

Remember: Most people find that the more support they get while trying to quit, the better! 

Your Quitting Plan

Knowing what’s ahead as you stop smoking can help you develop ways to overcome the challenges. It helps to think of quitting as following five stages: 

• Stage 1 — Not Yet Ready 

At this stage, you may have no intention of quitting. But you can do some research 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’re beginning to identify your concerns about quitting and plan strategies to overcome the challenges of giving up cigarettes. By thinking about a solution ahead of time, you can 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 should select a quit or reduce to quit date and develop coping strategies to help you succeed. 

• Stage 4 — Quitting Smoking 

You 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, seek support and advice to help you change your behaviour, control your surroundings, reduce stress and recover from the inevitable slip-ups. 

Pharmacotherapy

Nicotine creates a chemical dependency so that the body develops a need for a certain level of nicotine at all times. The use of medications helps alleviate this need. Medications designed to help you quit smoking are safe to use, and they have been shown to double or even triple your chances of successfully quitting.

The University of Ottawa Heart Institute’s Nicotine Addiction Treatment Plan recommends all smokers take advantage of available quit-smoking medication. The booklet provides the following information about nicotine replacement therapy and drugs that help reduce cravings. 

Nicotine Replacement Therapy (NRT)  

NRT helps to reduce your withdrawal symptoms, like cravings to smoke, anxiety, irritability, headaches, and difficulty concentrating, that commonly occur when trying to quit smoking. You receive much less nicotine from NRT than if you continue to smoke and does not expose you to the chemicals in cigarette smoke.  NRT comes in the form of patch, inhaler, gum, lozenge or mouth spray. Each form can be used alone or often two or more forms of NRT are used together. The type, amount, and length of NRT treatment can be changed to meet your needs. 

Long Acting NRT: The Patch  

The patch is placed on a clean, dry, non-hairy area of your body (arm, back or abdomen) and works to slowly release nicotine into the body. It should be replaced with a new patch each day. Available in 7mg, 14mg and 21mg patches.

The rule of thumb is to replace each cigarette with 1mg of NRT. If you smoke within 30 minutes of waking up, consider adding a 7mg patch or short acting NRT to your starting dose.  

Short Acting NRT: Inhaler, Gum, Lozenge, Mouth Spray  

Short acting NRT can be added to the patch or used on their own at any time to help better manage your cravings. The inhaler is used by taking small puffs into your mouth and holding them for a few seconds (do not inhale) and can be used until the cravings are gone. 

NRT gum is used correctly with the park and chew method. Chew slowly a few times then stop and park the piece of gum between your cheek and gums for about one minute and repeat. The cycle can be repeated until the craving passes up to 30 minutes.

Lozenges are put into the mouth and dissolved over 20 to 30 minutes, occasionally moving it side to side. They are not to be chewed or swallowed. 

NRT mouth spray is used until the tongue or on the inside of the cheek, spraying only one time in 15 minutes. Avoid inhaling or swallowing for a few seconds after a spray.  

Prescription Medications  

Varenicline (Champix) comes in pill form and works to target the nicotine receptors in your brain. It helps to reduce cravings for nicotine and takes away the satisfaction you get from smoking. Varenicline should be started 8 – 35 days before your quit date. 

Bupropion (Zyban) is another pill option that helps balance the chemicals in your brain to reduce nicotine cravings and withdrawal. It should be started at least seven days before your quit date. 

If you notice changes in your behaviour that are not normal for you (e.g., agitation, depressed mood) or if you have an allergic reaction, stop taking the medication and contact your healthcare provider immediately.  

It’s true that NRT and medications come with a price tag but consider this: The average cost of smoking one pack of cigarettes in Ontario is about $12.50 per day, $87.50per week, or $4,550 per year.⁶ Think of the money you will save over the long term once you quit!

For more information on pharmacotherapy options check out these Smoking Cessation Myth Busters.  

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/reduce to quit date by taking note of the following: 

• The times of day in which you smoke 
• What you’re feeling when you smoke 
• 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. 

Relapse Prevention

It’s normal to relapse. Before it happens, make sure you have a plan for getting back on track.

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 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 plan. 

Any amount of smoking — light, occasional, or second-hand — is dangerous and likely to cause damage to your cardiovascular system and many other parts of your body.

More than 48,000 Canadians will die prematurely each year from tobacco use and almost 9937 non-smokers will die from exposure to second-hand smoke.⁷ But no matter how long you have smoked, quitting will greatly improve your health.

Take advantage of the resources in our community and online to get advice and support — and get started. 

RESOURCES

Community Programs 

• UOHI Quit Smoking Program 
• MyQuit  
• OMSC Community Program  

Online Support  

• STOP on the Net  
• Smoker’s Helpline  
• Nicotine Dependence Webinar  

Pharmacies, Family Health Teams and Community Health Centres 

Did you know that your pharmacist or family healthcare team can assist you with making changes to your smoking? Ask your local pharmacists or healthcare provider about the smoking cessation resources available to you. To find a local service visit Health Connect Ontario and search for smoking cessation programs in your area.