Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Even one cigarette a day greatly raises cardiovascular risk, experts warn

Impact of one daily cigarette on risk of heart disease and stroke greater than previously thought

Read more: https://www.theguardian.com/society/2018/jan/24/even-one-cigarette-a-day-greatly-raises-cardiovascular-risk-experts-warn

Threats, bullying, lawsuits: tobacco industry’s dirty war for the African market

Revealed: In pursuit of growth in Africa, British American Tobacco and others use intimidatory tactics to attempt to suppress health warnings and regulation

British American Tobacco (BAT) and other multinational tobacco firms have threatened governments in at least eight countries in Africa demanding they axe or dilute the kind of protections that have saved millions of lives in the west, a Guardian investigation has found.

BAT, one of the worlds leading cigarette manufacturers, is fighting through the courts to try to block the Kenyan and Ugandan governments attempts to bring in regulations to limit the harm caused by smoking. The giant tobacco firms hope to boost their markets in Africa, which has a fast-growing young and increasingly prosperous population.

In one undisclosed court document in Kenya, seen by the Guardian, BATs lawyers demand the countrys high court quash in its entirety a package of anti-smoking regulations and rails against what it calls a capricious tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

Tobacco: a deadly business

BAT in Uganda asserts in another document that the governments Tobacco Control Act is inconsistent with and in contravention of the constitution.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

BAT denies it is opposed to all tobacco regulation, but says it reserves the right to ask the courts to intervene where it believes regulations may not comply with the law.

Later this month, BAT is expected to become the worlds biggest listed tobacco firm as it completes its acquisition of the large US tobacco company Reynolds in a $49bn deal, and there are fears over the extent to which big tobacco can financially outmuscle health ministries in poorer nations. A vote on the deal by shareholders of both firms is due to take place next Wednesday, simultaneously in London at BAT and North Carolina at Reynolds.

Professor Peter Odhiambo, a former heart surgeon who is head of the governments Tobacco Control Board in Kenya, told the Guardian: BAT has done as much as they can to block us.

Experts say Africa and southern Asia are urgent new battlegrounds in the global fight against smoking because of demographics and rising prosperity. Despite declining smoking and more controls in some richer countries, it still kills more than seven million people globally every year, according to the WHO, and there are fears the tactics of big tobacco will effectively succeed in exporting the death and harm to poorer nations.

There are an estimated 77 million smokers in Africa and those numbers are predicted to rise by nearly 40% from 2010 levels by 2030, which is the largest projected such increase in the world.

In Kenya, BAT has succeeded in delaying regulations to restrict the promotion and sale of cigarettes for 15 years, fighting through every level of the legal system. In February it launched a case in the supreme court that has already halted the imposition of tobacco controls until probably after the countrys general election in August, which are being contested by parliamentarians who have been linked to payments by the multinational company.

In Uganda, BAT launched legal action against the government in November, arguing that the Tobacco Control Act, which became law in 2015, contravenes the constitution. It is fighting restrictions that are now commonplace in richer countries, including the expansion of health warnings on packets and point-of-sale displays, arguing that they unfairly restrict its trade.

The court actions are brought by BATs local affiliates, BAT Kenya and BAT Uganda, but approved at Globe House, the London headquarters of the multinational, which receives most of the profits from the African trade. In its 2016 annual report, BAT outlined the risk that unreasonable litigation would be brought in to control tobacco around the world. Its response was an engagement and litigation strategy coordinated and aligned across the Group.

Focus on emerging markets

British
British packets of cigarettes, with stark warnings, beside packs from Africa. Photograph: Linda Nylind for the Guardian

At its annual meeting in March, chairman Richard Burrows toasted a vintage year for BAT, as profits rose 4% to 5.2bn after investors took their cut their dividend had increased by 10%. When asked about the legal actions in Africa, he said tobacco was an industry that should be regulated … but we want to see that regulation is serving the correct interests of the health mission and human mission which should lie behind it.

So, from time to time its necessary for us to take legal action to challenge new regulation which he said was led by the local board.

BAT says it is simply not true that we oppose all tobacco regulation, particularly in developing countries. Tobacco should be appropriately regulated as a product that has risks to health, it said, but where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it. It was opposed to only a handful of the issues in Kenyas regulations, not the entirety, it said in a statement.

Although most countries in Africa have signed the World Health Organisation (WHO) treaty on tobacco control, none has yet fully implemented the smoking restrictions it endorses.

The WHO predicts that by 2025, smoking rates will go up in 17 of the 30 Africa-region countries from their 2010 level. In some countries a massive hike is expected in Congo-Brazzaville, from 13.9% to nearly half the population (47.1%) and in Cameroon from 13.7% to 42.7%. In Sierra Leone it will be 41.2% (74% among men) and in Lesotho 36.9%.

The tobacco industrys march on Africa

In contrast, research showed last year that just 16.9% of adults smoke in the UK; and last month new figures showed UK heart disease deaths had fallen 20% since that countrys indoor smoking ban.

The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continents patchwork tobacco control regulations and limited resources to combat industry marketing advances, said Dr Emmanuela Gakidou and colleagues at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, publishing an analysis of smoking prevalence around the world in the Lancet in April.

Africas growing numbers of children and young people, and its increasing wealth, represent a huge future market for the tobacco industry. The companies deny targeting children and cannot sell packs smaller than 10, but a new study carried out in Nairobi by the Johns Hopkins school of public health in the US and the Kenya-based Consumer Information Network found vendors selling cigarettes along the routes children take to walk to primary schools.

Graphic

Stalls sell single Dunhill, Embassy, Safari and other BAT cigarette sticks, costing around 4p (5 cents) each, alongside sweets, biscuits and fizzy drinks. The vendors split the packets of 20 manufactured by BAT. They are targeting children, said Samuel Ochieng, chief executive of the Consumer Information Network. They mix cigarettes with candies and sell along the school paths.

BAT said that its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, given our investment in the brands and the fact there are clear health warnings on the packs.

Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.

Links with politicians

Cigarettes
Cigarettes on sale (alongside sweets) in Nairobi, Kenya. Photograph: David Levene for the Guardian

The Kenya case, expected to be heard after the elections on 8 August, is seen as critical for the continent. If the government loses, other countries will have less appetite for the long and expensive fight against the wealthy tobacco industry.

BAT has around 70% of the Kenyan market; its Kenyan competitor, Mastermind, has joined in the legal action against the government.

Concerns have been raised about links between politicians and the tobacco companies. There are allegations of some of them having been bribed in the past, said Joel Gitali, chief executive of the Kenya Tobacco Control Alliance.

BAT whistleblower Paul Hopkins, who worked in Africa for BAT for 13 years, told a British newspaper he paid bribes on the companys behalf to the Kenya Revenue Authority for access to information BAT could use against its Kenyan competitor, Mastermind. Hopkins has also alleged links between certain prominent opposition Kenyan politicians and two tobacco companies, BAT Kenya and Mastermind. Hopkins, who says he alerted BAT to the documents before the company made him redundant, claimed BAT Kenya paid bribes to government officials in Burundi, Rwanda and the Comoros Islands to undermine tobacco control regulations. Gitali is concerned about the outcome of the election: If the opposition takes over government we shall be deeply in the hands of the tobacco companies.

BAT denies any wrongdoing. A spokesperson said: We will not tolerate improper conduct in our business anywhere in the world and take any allegations of misconduct extremely seriously. We are investigating, through external legal advisors, allegations of misconduct and are liaising with the Serious Fraud Office and other relevant authorities.

We grow up dreaming we can be one of them

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The headquarters and factory of British American Tobacco in Nairobi, Kenya. Photograph: David Levene for the Guardian

Tih Ntiabang, regional coordinator for Africa of the Framework Convention Alliance NGOs that support the WHO treaty said the tobacco companies had become bolder. In the past it used to be invisible interference, but today it is so shameful that it is so visible and they are openly opposing public health treaties like the case in Kenya at the moment Today they boldly go to court to oppose public health policy. Every single government is highly interested in economic growth. They [the tobacco companies] know they have this economic power. The budget of tobacco companies like BAT could be as much as the whole budget of the Africa region.

Our health systems are not really well organised. Our policy makers cant see clearly what are the health costs of inaction on tobacco control because our health system is not very good. It puts the tobacco industry at an advantage on public health.

The sale across the whole of Africa of single cigarette sticks was a serious problem because it enabled children to buy them. They are extremely affordable. Young teenagers are able to purchase a cigarette. You dont need 1 for a pack of 20, he said.

There are fears the number of deaths and illnesses in Africa from tobacco could rise dramatically

BAT has a reputation in Africa as an employer offering steady and well-paid jobs, said Ntiabang, based in Cameroon. When I was about 10, I was always dreaming I could work for BAT. They have always painted themselves as a responsible company a dream company to work for. All the staff are well-off. The young people think I want to work for BAT. They promote a lot of events and make their name appear to young people. We grow up dreaming we can be one of them.

In Uganda in 2014, BAT managing director, Jonathan DSouza, sent a 13-page detailed attack on the tobacco control bill, then going through parliament, to the chair of the governments health committee.

BAT was contracting with 18,000 farmers and paid them 61bn Ugandan shillings for 16.8m kg of tobacco in 2013, said the letter. The economy has benefited significantly from BAT Ugandas investments, it said. This has helped to alleviate poverty and improve welfare in urban and rural areas, it says.

BAT Uganda (BATU) agreed tobacco should be regulated while respecting the informed choices and rights of adults who choose to smoke and the legal rights of a legal industry. But it cited 11 areas of concern, claiming there is no evidence to support a ban on tobacco displays in shops, that large graphic health warnings on packs are ineffective, that proposals on bans on smoking in public places were too broad and that prohibiting smoking under the age of 21 was unreasonable, since at 18 young people are adults and can make up their own mind.

Documents made public by the University of Bath show that BATU had another concern: the ban on the sale of cheap single cigarettes. Adults should be free to purchase what they can afford, says an internal leaked paper. BATU also took action against the MP who sponsored the bill. A letter informed him that the company would no longer be contracting with the 709 tobacco farmers in his region. There is evidence that the company also lobbied other MPs with tobacco farmers in their constituencies.

The Tobacco Control Act became law in 2015, and in November last year, BAT sued. Many people choose to smoke, said an affidavit to the court from managing director Dadson Mwaura and it was important to ensure regulation did not lead to unintended consequences that risk an untaxed and unrestrained illegitimate trade in tobacco products. BATUs legal product contributed to the Ugandan economy in many dimensions.

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A vendor in Nairobis Uhuru Park sells single stick cigarettes. Photograph: David Levene for the Guardian

The Guardian has seen letters showing that at least six other African governments have faced challenges from the multinational tobacco companies over their attempts to control smoking.

  • Democratic Republic of Congo: Letter to the president sent in April 2017 by the Fdration des Entreprises du Congo (chamber of commerce) on behalf of the tobacco industry, listing 29 concerns with the proposed tobacco control regulations, which they claim violate the constitution, international agreements and domestic law.
  • Burkina Faso: Letter sent in January 2016 to the minister of health from Imperial Tobacco, warning that restrictions on labeling and packaging cigarettes risks economic and social damage to the country. Previous letter sent to the prime minister from the US Chambers of Commerce in December 2013 warning that large health warnings and plain packaging could put Burkina Faso in breach of its obligations to the World Trade Organisation.
  • Ethiopia: Letter sent in February 2015 to the ministers of health and science and technology by Philip Morris International, claiming that the governments tobacco directive banning trademarks, brands and added ingredients to tobacco breached existing laws and would penalise all consumer retailers.
  • Togo: Letter to the minister of commerce in June 2012 from Philip Morris International opposing plain packaging, which risks having damaging consequences on Togos economy and business environment.
  • Gabon: Letter from BAT arguing that there is no evidence that plain packaging reduces smoking, citing the Deloitte report of 2011, alleging its introduction would put Gabon in breach of trade agreements and promote smuggling.
  • Namibia: Letter to the minister of health from BAT, warning that planned tobacco controls will have a massive impact on the Namibian economy at large.

Bintou Camara, director of Africa programs at Campaign for Tobacco-Free Kids, said: British American Tobacco, Philip Morris International and other multinational tobacco companies have set their sights on Africa as a growth market for their deadly products. Throughout Africa, tobacco companies have tried to intimidate countries from taking effective action to reduce tobacco use, the worlds leading cause of preventable death, he added.

Governments in Africa should know that they can and should move forward with measures aimed at preventing and reducing tobacco use and that they do so with the support of the many governments and leaders around the world that have taken strong action to protect public health.

Cloe Franko, senior international organizer at Corporate Accountability International, said: In Kenya, as in other parts of the world, the industry has resorted to frivolous litigation, aggressive interference … to thwart, block, and delay lifesaving policies. BATs actions are emblematic of a desperate industry grasping to maintain its hold over countries and continue to peddle its deadly product.

Philip Morris said it is regularly engaged in discussions with governments. We are approached by or approach public authorities to discuss a range of issues that are important for them and for us, such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best. It said that it supports effective regulation, including laws banning sales to minors, mandatory health warnings, and advertising restrictions.

Imperial Tobacco said it sold its brands where theres a legitimate and existing demand for tobacco and take the same responsible approach in Africa as we do in any Western territory. A spokesman said it supported reasonable, proportionate and evidence-based regulation of tobacco, including health warnings that are consistent with global public health messages. But, it said, Imperial would continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals.

Read more: https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market

Health effects of coffee: Where do we stand?

(CNN)It’s one of the age-old medical flip-flops: First coffee’s good for you, then it’s not, then it is — you get the picture.

Today, the verdict is thumbs up, with study after study extolling the merits of three to five cups of black coffee a day in reducing risk for everything from melanoma to heart disease, multiple sclerosis, type 2 diabetes, Parkinson’s disease, liver disease, prostate cancer, Alzheimer’s, computer-related back pain and more.
To stay completely healthy with your coffee consumption, you’ll want to avoid packing it with calorie laden creams, sugars and flavors. And be aware that a cup of coffee in these studies is only 8 ounces; the standard “grande” cup at the coffee shop is double that at 16 ounces.
    And how you brew it has health consequences. Unlike filter coffee makers, the French press, Turkish coffee or the boiled coffee popular in Scandinavian countries fail to catch a compound called cafestol in the oily part of coffee that can increase your bad cholesterol or LDL.
    Finally, people with sleep issues or uncontrolled diabetes should check with a doctor before adding caffeine to their diets, as should pregnant women, as there is some concern about caffeine’s effect on fetal growth and miscarriage. And some of the latest research seems to say that our genes may be responsible for how we react to coffee, explaining why some of us need several cups to get a boost while others get the jitters on only one.
    But as you know, the news on coffee has not always been positive. And the argument over the merits of your daily cup of joe dates back centuries. Let’s take a look at the timeline.
    1500’s headline: Coffee leads to illegal sex
    Legend has it that coffee was discovered by Kaldi, an Ethiopian goatherd, after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself. But it was the Arabs who first started coffeehouses, and that’s where coffee got its first black mark.
    Patrons of coffeehouses were said to be more likely to gamble and engage in “criminally unorthodox sexual situations,” according to author Ralph Hattox. By 1511 the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast believe it was more likely a reaction to the unpopular comments about his leadership. The ban didn’t last long, says Pendergrast, adding that coffee became so important in Turkey that “a lack of sufficient coffee provided grounds for a woman to seek a divorce.”
    1600’s headline: Coffee cures alcoholism but causes impotence
    As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasn’t always safe to drink, so most men, women and even children drank the hard stuff.
    Local ads such as this one in 1652 by coffee shop owner Pasqua Rose popularized coffee’s healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches and stomachaches, even prevent miscarriages.
    But in London, women were concerned that their men were becoming impotent, and in 1674 The Women’s Petition Against Coffee asked for the closing of all coffeehouses, saying in part: “We find of late a very sensible Decay of that true Old English Vigour. … Never did Men wear greater Breeches, or carry less in them…”
    1700’s headline: Coffee helps you work longer
    By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.
    1800’s headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead
    In the mid-1800s America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kellogg’s “Caramel Coffee” and C.W. Post’s “Postum” (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Post’s ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.
    1916 headline: Coffee stunts your growth
    While inventions and improvements in coffee pots, filters and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.
    Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffee’s impact on common aliments of the era, such as nervousness, heart palpitations, indigestion and insomnia.
    1927 headline: Coffee will give you bad grades, kids
    In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the “startling” fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.
    1970’s and ’80’s headline: Coffee is as serious as a heart attack
    A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.
    Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.
    A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who don’t consume coffee. But the study only asked questions every five years, and didn’t isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or “Doooonuts,” if you’re Homer Simpson.
    Millennium headline: Coffee goes meta
    Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, can’t “tip the balance” one way or another. We take a look at some of the years. The results for coffee? Mostly good.
    2001 headline: Coffee increases risk of urinary tract cancer
    But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.
    2007 headline: Coffee decreases risk of liver cancer
    Some of these data analyses found preventive benefits for cancer from drinking coffee, such as this one, which showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.
    2010 headline: Coffee and lung disease go together like coffee and smoking
    A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.
    2011 headline: Coffee reduces risk of stroke and prostate cancer
    A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.
    As for prostate cancer, this 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.
    2012 headline: Coffee lowers risk of heart failure
    More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.
    2013 headline: Coffee lowers risk of heart disease and helps you live longer
    For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasn’t a higher risk among those who drank more than five cups a day.
    How about coffee’s effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.
    2015 headline: Coffee is practically a health food
    As a sign of the times, the U.S. Department of Agriculture now agrees that “coffee can be incorporated into a healthy lifestyle,” especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar. You can read their analysis of the latest data on everything from diabetes to chronic disease here.
    2017 headline: Yes, coffee still leads to a longer life
    The largest study to date on coffee and mortality surveyed 520,000 people in 10 European countries and found that regularly drinking coffee could significantly lower the risk of death.
    Another study with a focus on non-white populations had similar findings. That study surveyed 185,000 African-Americans, Native Americans, Hawaiians, Japanese-Americans, Latinos and whites. The varying lifestyles and dietary habits of the people observed in both studies led the authors to believe that coffee’s impact on longevity doesn’t have to do with how its prepared or how people drink it — it has to do with the beverage’s biological effect on the body.
    But stay tuned. There’s sure to be another meta-study, and another opinion. We’ll keep you updated.

    Read more: http://www.cnn.com/2015/08/14/health/coffee-health/index.html

    British Heart Foundation – Smoking and heart disease

    If you smoke, you're more than twice as likely to have a heart attack than someone who doesn't.

    Lisa shares how she managed to quit for good, and the benefits its brought her.

    Cardiology: Do You Know The Warning Signs of Heart Disease?

    Edward Palank, M.D., talks about the risks and warning signs of heart disease.

    Smoking Causes Cancer, Heart Disease, Emphysema

    – This 3D medical animation created by Nucleus Medical Media shows the health risks of smoking tobacco.

    ID#: ANH12071

    Transcript:
    Every time you smoke a cigarette, toxic gases pass into your lungs, then into your bloodstream, where they spread to every organ in your body. A cigarette is made using the tobacco leaf, which contains nicotine and a variety of other compounds. As the tobacco and compounds burn, they release thousands of dangerous chemicals, including over forty known to cause cancer. Cigarette smoke contains the poisonous gases carbon monoxide and nitrogen oxide, as well as trace amounts of cancer-causing radioactive particles. All forms of tobacco are dangerous, including cigars, pipes, and smokeless tobacco, such as chewing tobacco and snuff.

    Nicotine is an addictive chemical in tobacco. Smoking causes death. People who smoke typically die at an earlier age than non-smokers. In fact, 1 of every 5 deaths in the United States is linked to cigarette smoking.

    If you smoke, your risk for major health problems increases dramatically, including: heart disease, heart attack, stroke, lung cancer, and death from chronic obstructive pulmonary disease.
    Smoking causes cardiovascular disease.

    When nicotine flows through your adrenal glands, it stimulates the release of epinephrine, a hormone that raises your blood pressure. In addition, nicotine and carbon monoxide can damage the lining of the inner walls in your arteries. Fatty deposits, called plaque, can build up at these injury sites and become large enough to narrow the arteries and severely reduce blood flow, resulting in a condition called atherosclerosis. In coronary artery disease, atherosclerosis narrows the arteries that supply the heart, which reduces the supply of oxygen to your heart muscle, increasing your risk for a heart attack. Smoking also raises your risk for blood clots because it causes platelets in your blood to clump together. Smoking increases your risk for peripheral vascular disease, in which atherosclerotic plaques block the large arteries in your arms and legs. Smoking can also cause an abdominal aortic aneurysm, which is a swelling or weakening of your aorta where it runs through your abdomen.

    Smoking damages two main parts of your lungs: your airways, also called bronchial tubes, and small air sacs called alveoli. Cigarette smoke irritates the lining of your bronchial tubes, causing them to swell and make mucus. Cigarette smoke also slows the movement of your cilia, causing some of the smoke and mucus to stay in your lungs. While you are sleeping, some of the cilia recover and start pushing more pollutants and mucus out of your lungs. When you wake up, your body attempts to expel this material by coughing repeatedly, a condition known as smoker's cough. Over time, chronic bronchitis develops as your cilia stop working, your airways become clogged with scars and mucus, and breathing becomes difficult.

    Your lungs are now more vulnerable to further disease. Cigarette smoke also damages your alveoli, making it harder for oxygen and carbon dioxide to exchange with your blood. Over time, so little oxygen can reach your blood that you may develop emphysema, a condition in which you must gasp for every breath and wear an oxygen tube under your nose in order to breathe.

    Chronic bronchitis and emphysema are collectively called chronic obstructive pulmonary disease, or COPD. COPD is a gradual loss of the ability to breathe for which there is no cure.

    Cigarette smoke contains at least 40 cancer-causing substances, called carcinogens, including cyanide, formaldehyde, benzene, and ammonia. In your body, healthy cells grow, make new cells, then die. Genetic material inside each cell, called DNA, directs this process. If you smoke, toxic chemicals can damage the DNA in your healthy cells. As a result, your damaged cells create new unhealthy cells, which grow out of control and may spread to other parts of your body. Cigarettes can cause cancer in other parts of your body, such as: in the blood and bone marrow, mouth, larynx, throat, esophagus, stomach, pancreas, kidney, bladder, uterus, and cervix.

    Smoking can cause infertility in both men and women. If a woman is pregnant and smokes during pregnancy, she exposes her baby to the cigarette's poisonous chemicals, causing a greater risk of: low birth weight, miscarriage, preterm delivery, stillbirth, infant death, and sudden infant death syndrome. Smoking is also dangerous if a mother is breastfeeding. Nicotine passes to the baby through breast milk, and can cause restlessness, rapid heartbeat, vomiting, interrupted sleep, or diarrhea.

    Other health effects of smoking include: low bone density and increased risk for hip fracture among women; gum disease, often leading to tooth loss and surgery; immune system dysfunction and delayed wound healing; and sexual impotence in men.