Tobacco: A Highly Addictive Toxin

Smoking is the most immediately reversible contributor to heart disease.  It acutely activates platelets, which are cell parts in the bloodstream that help form clots.  So, within 24 hours of quitting smoking, your blood becomes less “sticky,” lowering the tendency to having a heart attack.  By the same token, though, don’t think that “one cigarette won’t hurt me.”  That could be the one that triggers the blood to clot off an artery!  Furthermore, nicotine, which is what makes tobacco so addictive, acts as a vasoconstrictor—tightening the arteries and diminishing the blood flow immediately.

Smoking also has long term effects that promote atherosclerosis (plaque build-up in arteries).  The combustion of tobacco releases thousands of molecules into the airway, which enter the bloodstream through the lungs.  Many of these molecules cause irritation and inflammation of the blood vessels.  Some of these substances are oxidative, which is harmful to the body in general and the blood vessels in particular.  So, while it is true that a person’s risk of a heart attack drops immediately upon quitting smoking, it doesn’t reverse the long-term atherosclerotic effects of tobacco on the blood vessels.  The good news is—the less, the better.  Cutting down on tobacco use lowers the “dose” of the harmful effects.  Of course, complete cessation is best.

As I mentioned above, nicotine is the substance that drives people to smoke.  It gives people a high and is tremendously addictive.  But there are many options out there nowadays to help people quit, ranging from “nicotine substitutes” like nicotine patches and nicotine gum to medications that can decrease the craving for nicotine.  These include bupropion and varenicline—and other drugs are being developed.

Recently vaping has become a popular alternative to smoking.  The jury is still out on how risky that is, but it is reasonable to believe that it is less harmful than smoking tobacco.  Vaping doesn’t produce nearly as manytoxic substances as smoking does.  However, “not as many” does not mean “none” and they that can also be damaging to the airway and lungs.  Furthermore, as I indicated earlier, nicotine itself is harmful by constricting the blood vessels.  So, if you aren’t a smoker, please don’t start vaping!  And if you are a smoker and have not been able to quit through other methods, consider vaping with the goal to gradually wean yourself off of it.

One other method I have suggested to patients that can be helpful: don’t tell yourself you are quitting.  Just put off that next cigarette.  When you’ve gone an hour without smoking, decide that you can go 3 hours.  When you’ve done that, try for a day without a cigarette.  Then string a few of those together.  The psychological trick is that you never feel the panic of having quit, that “Oh my God, I can’t imagine never having a cigarette again!”  You tell yourself that you can smoke whenever you want to, but you’re just not going to do it right now.  Maybe later.

Good luck to those of you struggling with this very intractable problem!

Greg Koshkarian, MD, FACC


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Gregory Koshkarian, MD, FACC