Smoking and heart disease

Coronary heart disease and sudden death occur more frequently among heavy smokers than among nonsmokers, and sudden death is often the first manifestation of coronary heart disease. Smoking has also been shown to aggravate attacks of angina pectoris. Two factors which have been implicated in the development of coronary heart disease among smokers are nicotine (which stimulates the secretion of catecholamines) and carbon monoxide. There is evidence that smoking also influences platelet adhesiveness and aggregation, as well as their survival time. Cigar and pipe smoking have been associated with a lower incidence of coronary heart disease, when compared with cigarette smoking. Mortality rates associated with coronary heart disease decrease progressively after cessation of smoking. The prevention of coronary heart disease by providing advice against smoking and other risk factors could become one of the most rewarding activities in medical practice.