Cancer, Heart Diseases, and Common Risk Factors: Smoke

  • Annamaria Catino
  • Andrea Misino
  • Antonio Logroscino
  • Elisabetta Sara Montagna
  • Domenico Galetta


Cardiovascular disease is the leading cause of death worldwide, with approximately 30 % of deaths. Several studies have demonstrated that both cardiovascular morbidity and mortality are increased by cigarette smoke exposure, and this correlation has been confirmed also for environmental tobacco exposure. Epidemiologic data show that most of the damages produced by smoke exposure reverse quickly after cessation. Thus, smoking cessation is a crucial issue of cardiovascular prevention.

Lung cancer is the leading cause of cancer morbidity and mortality worldwide, and 90 % of the annual cancer deaths worldwide are attributable to cigarette smoke, including passive smoking as a strong risk factor. Smoking is directly involved in carcinogenesis; among the over 5000 compounds identified in cigarette smoke, more than 70 substances are carcinogens. The relative risk increases with amount smoked, duration, earlier starting age, tar level, and fraction smoked and decreases with time quit. Smoking cessation improves risk and mortality from cardiovascular disease and lung cancer; therefore, it is a priority, for the public health system, to reduce smoking prevalence through effective tobacco control policies.


  1. 1.
    Santulli G. Epidemiology of cardiovascular disease in the 21st century: updated numbers and updated facts. J Cardiovasc Dis. 2013;1(1):1–2.Google Scholar
  2. 2.
    Doll R, Peto R. Mortality in relation to smoking: 20 years’ observations on male British doctors. BMJ. 1976;2:1525–36.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Doll R, Gray R, Hafner B, Peto R. Mortality in relation to smoking: 22 years’ observations on female British doctors. BMJ. 1980;280:967–71.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987;317:1303–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh artery study. Eur Heart J. 1999;20:344–53.CrossRefPubMedGoogle Scholar
  6. 6.
    Jonas MA, Oates JA, Ockene JK, Hennekens CH. Statement on smoking and cardiovascular disease for health care professionals: American Heart Association. Circulation. 1992;86:1664–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Negri E, Franzosi MG, La Vecchia C, Santoro L, Nobili A, Tognoni G. Tar yield of cigarettes and risk of acute myocardial infarction: GISSI-EFRIM Investigators. BMJ. 1993;306:1567–70.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ. 1997;315:973–80.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Benowitz NL. Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. Prog Cardiovasc Dis. 2003;1:91–111.CrossRefGoogle Scholar
  10. 10.
    Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis. 2003;46:11–29.CrossRefPubMedGoogle Scholar
  11. 11.
    Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004;43:1731–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Law MR, Wald NJ. Environmental tobacco smoke and ischemic heart disease. Prog Cardiovasc Dis. 2003;46:31–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Pryor WA, Stone K. Oxidants in cigarette smoke: radicals, hydrogen peroxide, peroxynitrate, and peroxynitrite. Ann N Y Acad Sci. 1993;686:12–28.CrossRefPubMedGoogle Scholar
  14. 14.
    Glantz SA, Parmley WW. Passive smoking and heart disease: epidemiology, physiology, and biochemistry. Circulation. 1991;83:1–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Burke A, FitzGerald GA. Oxidative stress and smoking-induced tissue injury. Prog Cardiovasc Dis. 2003;46:79–90.CrossRefPubMedGoogle Scholar
  16. 16.
    Penn A, Snyder CA. 1,3 butadiene, a vapor phase component of environmental tobacco smoke, accelerates arteriosclerotic plaque development. Circulation. 1996;93:552–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Quillen JE, Rossen JD, Oskarsson HJ, et al. Acute effect of cigarette smoking on the coronary circulation: constriction of epicardial and resistance vessels. J Am Coll Cardiol. 1993;22:642–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Kaijser L, Berglund B. Effect of nicotine on coronary blood-flow in man. Clin Physiol. 1995;5:541–52.CrossRefGoogle Scholar
  19. 19.
    Celermajer DS, Sorensen KE, Georgakopoulos D, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation. 1993;88:2149–55.CrossRefPubMedGoogle Scholar
  20. 20.
    Puranik R, Celermajer DS. Smoking and endothelial function. Prog Cardiovasc Dis. 2003;45:443–58.CrossRefPubMedGoogle Scholar
  21. 21.
    Kojda G, Harrison D. Interactions between NO and reactive oxygen species: pathophysiological importance in atherosclerosis, hypertension, diabetes and heart failure. Cardiovasc Res. 1999;43:562–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Nedeljkovic ZS, Gokce N, Loscalzo J. Mechanisms of oxidative stress and vascular dysfunction. Postgrad Med J. 2003;79:195–200.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Heitzer T, Brockhoff C, Mayer B, et al. Tetrahydrobiopterin improves endothelium-dependent vasodilation in chronic smokers: evidence for a dysfunctional nitric oxide synthase. Circ Res. 2000;86:E36–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Kayyali US, Budhiraja R, Pennella CM, et al. Upregulation of xanthine oxidase by tobacco smoke condensate in pulmonary endothelial cells. Toxicol Appl Pharmacol. 2003;188:59–68.CrossRefPubMedGoogle Scholar
  25. 25.
    Heitzer T, Just H, Munzell T. Antioxidant vitamin C improves endothelial dysfunction in chronic smokers. Circulation. 1996;94:6–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Fennessy FM, Moneley DS, Wang JH, Kelly CJ, Bouchier-Hayes DJ. Taurine and vitamin C modify monocyte and endothelial dysfunction in young smokers. Circulation. 2003;107:410–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Takajo Y, Ikeda H, Haramaki N, Murohara T, Imaizumi T. Augmented oxidative stress of platelets in chronic smokers: mechanisms of impaired platelet-derived nitric oxide bioactivity and augmented platelet aggregability. J Am Coll Cardiol. 2001;38:1320–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Chalon S, Moreno H, Benowitz NL, et al. Nicotine impairs endothelium-dependent dilatation in human veins in vivo. Clin Pharmacol Ther. 2000;67:391–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Sarabi M, Lind L. Short-term effects of smoking and nicotine chewing gum on endothelium-dependent vasodilation in young healthy habitual smokers. J Cardiovasc Pharmacol. 2000;35:451–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Neunteufl T, Heher S, Kostner K, et al. Contribution of nicotine to acute endothelial dysfunction in long-term smokers. J Am Coll Cardiol. 2002;39:251–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Krupski WC, Olive GC, Weber CA, et al. Comparative effects of hypertension and nicotine on injury-induced myointimal thickening. Surgery. 1987;102:409–15.PubMedGoogle Scholar
  32. 32.
    Heitzer T, Yla-Herttuala S, Luoma J, et al. Cigarette smoking potentiates endothelial dysfunction of fore-arm resistance vessels in patients with hypercholesterolemia. Role of oxidized LDL. Circulation. 1996;93:1346–53.CrossRefPubMedGoogle Scholar
  33. 33.
    Ichiki K, Ikeda H, Haramaki N, et al. Long-term smoking impairs platelet-derived nitric oxide re- lease. Circulation. 1996;94:3109–14.CrossRefPubMedGoogle Scholar
  34. 34.
    Newby DE, McLeod AL, Uren NG, et al. Impaired coronary tissue plasminogen activator release is associated with coronary atherosclerosis and cigarette smoking: direct link between endothelial dysfunction and atherothrombosis. Circulation. 2001;103:1936–41.CrossRefPubMedGoogle Scholar
  35. 35.
    Simpson AJ, Gray RS, Moore NR, et al. The effects of chronic smoking on the fibrinolytic potential of plasma and platelets. Br J Haematol. 1997;97:208–13.CrossRefPubMedGoogle Scholar
  36. 36.
    Jensen EJ, Pedersen B, Frederiksen R, et al. prospective study on the effect of smoking and nicotine substitution on leucocyte blood counts and relation between blood leucocytes and lung function. Thorax. 1998;53:784–9.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Tracy RP, Psaty BM, Macy E, et al. Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arterioscler Thromb Vasc Biol. 1997;17:2167–76.CrossRefPubMedGoogle Scholar
  38. 38.
    Tuut M, Hense H-W. Smoking, other risk factors and fibrinogen levels: evidence of effect modification. Ann Epidemiol. 2001;11:232–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.CrossRefPubMedGoogle Scholar
  40. 40.
    Totti III N, McCusker KT, Campbell EJ, et al. Nicotine is chemotactic for neutrophils and enhances neutrophil responsiveness to chemotactic peptides. Science. 1984;223:169–73.CrossRefPubMedGoogle Scholar
  41. 41.
    Yong T, Zheng MQ, Linthicum DS. Nicotine induces leukocyte rolling and adhesion in the cerebral microcirculation of the mouse. J Neuroimmunol. 1997;80:158–64.CrossRefPubMedGoogle Scholar
  42. 42.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMedGoogle Scholar
  43. 43.
    Torre LA, Bray F, Siegel RL, et al. Global cancer statistics,2012. CA Cancer J Clin. 2015;65:87–108.CrossRefPubMedGoogle Scholar
  44. 44.
    Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res. 2015;4(4):327–38.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Hecht SS. Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer. 2003;3:733–44.CrossRefPubMedGoogle Scholar
  46. 46.
    Leon ME, Peruga A, McNeill A, Kralikova E, Guha N, Minozzi S, Espina C, Schuz J. European code against cancer, 4th edition: tobacco and cancer. Cancer Epidemiol. 2015. doi: 10.1016/j.canep.2015.06.001 (in press).Google Scholar
  47. 47.
    Wang A, Kubo J, Luo J, Desai M, Hedlin H, Henderson M, et al. Active and passive smoking in relation to lung cancer incidence in the Women’s Health Initiative Observational Study prospective cohort. Ann Oncol. 2015;26:221–30.CrossRefPubMedGoogle Scholar
  48. 48.
    Thomas JL, Guo H, Carmella SG, et al. Metabolites of a tobacco-specific lung carcinogen in children exposed to secondhand or thirdhand tobacco smoke in their homes. Cancer Epidemiol Biomarkers Prev. 2011;20:1213–21.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Suwan-ampai P, Navas-Acien A, Strickland PT, et al. Involuntary tobacco smoke exposure and urinary levels of polycyclic aromatic hydrocarbons in the United States, 1999 to 2002. Cancer Epidemiol Biomarkers Prev. 2009;18:884–93.CrossRefPubMedGoogle Scholar
  50. 50.
    Hackshaw AK, Law MR, Wald NJ. The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ. 1997;315:980–8.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Stayner L, Bena J, Sasco AJ, et al. Lung cancer risk and workplace exposure to environmental tobacco smoke. Am J Public Health. 2007;97:545–51.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Oberg M, Jaakkola MS, Woodward A, et al. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377:139–46.CrossRefPubMedGoogle Scholar
  53. 53.
    Yu Y, Liu H, Zheng S, Ding Z, Chen Z, Jin W, Wang L, Wang Z, Fei Y, Zhang S, Ying K, Zhang R. Gender susceptibility for cigarette smoking-attributable lung cancer: a systematic review and meta-analysis. Lung Cancer. 2014;85:351–60.CrossRefPubMedGoogle Scholar
  54. 54.
    Lee PN, Forey BA, Coombs KJ. Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer. BMC Cancer. 2012;12:385.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Toh CK, Gao F, Lim WT, Leong SS, Fong KW, Yap SP, et al. Never-smokers with lung cancer: epidemiologic evidence of a distinct disease entity. J Clin Oncol. 2006;24:2245–51.CrossRefPubMedGoogle Scholar
  56. 56.
    Okamoto T, Suzuki Y, Fujishita T, Kitahara H, Shimamatsu S, Kohno M, Morodomi Y, Kawano D, Maehara Y. The prognostic impact of the amount of tobacco smoking in non-small cell lung cancer—differences between adenocarcinoma and squamous cell carcinoma. Lung Cancer. 2014;85:125–30.CrossRefPubMedGoogle Scholar
  57. 57.
    Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case–control studies. BMJ. 2000;321:323–9.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Personal habits and indoor combustions. A review of human carcinogens. International Agency for Research on Cancer. Monogr Eval Carcinog Risks Hum. 2012;1–538.Google Scholar
  59. 59.
    Pirie K, Peto R, Reeves GK, Green J, Beral V. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet. 2013;381:133–41.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Carter BD, Abnet CC, Feskanich D, Freedman ND, Hartge P, Lewis CE, Ockene JK, Prentice RL, Speizer FE, Thun MJ, Jacobs EJ. Smoking and mortality—beyond established causes. N Engl J Med. 2015;372:631–40.CrossRefPubMedGoogle Scholar
  61. 61.
    Carrozzi L, Falcone F, Carreras G, Pistelli F, Gorini G, Martini A, Viegi G. Life gain in Italian smokers who quit. Int J Environ Res Public Health. 2014;11:2395–406.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Ma J, Ward EM, Smith R, et al. Annual number of lung cancer deaths potentially avertable by screening in the United States. Cancer. 2013;119:1381–5.CrossRefPubMedGoogle Scholar
  63. 63.
    Gallus S, Lugo A, La Vecchia C, et al. Pricing policies and control of tobacco in Europe (PPACTE) project:cross-national comparison of smoking prevalence in 18 European countries. Eur J Cancer Prev. 2014;23:177–85.CrossRefPubMedGoogle Scholar
  64. 64.
    Gallus S, Lugo A, La Vecchia C, et al. Pricing policies and control of tobacco in Europe (PPACTE) project: smoking prevalence and consumption in 18 European countries. Final report. Dublin: PPACTE Consortium; 2011.Google Scholar
  65. 65.
    World Health Organization. WHO report on the global tobacco epidemic, 2015: raises taxes on tobacco—executive summary. Available online ►
  66. 66.
    Moolgavkar SH, Holford TR, Levy DT, et al. Impact of reduced tobacco smoking on lung cancer mortality in the United States during 1975–2000. J Natl Cancer Inst. 2012;104:541–8.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Cesaroni G, Forastiere F, Agabiti N, et al. Effect of the Italian smoking ban on population rates of acute coronary events. Circulation. 2008;117:1183–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med. 2008;359:482–91.CrossRefPubMedGoogle Scholar
  69. 69.
    Mackay DF, Irfan MO, Haw S, et al. Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. Heart. 2010;96:1525–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Annamaria Catino
    • 1
  • Andrea Misino
    • 1
  • Antonio Logroscino
    • 1
  • Elisabetta Sara Montagna
    • 1
  • Domenico Galetta
    • 1
  1. 1.IRCCS “Giovanni Paolo II” Clinical Cancer CenterBariItaly

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