Cardiovascular benefits of smoking cessation.

Cigarette smoking causes significant exposure to nicotine, which increases heart rate, blood pressure, and thus myocardial oxygen demand, and to carbon monoxide, which decreases the oxygen-carrying capacity of the blood because of carboxyhemoglobin formation. Cigarette smoking also predisposes the patient to coronary vasoconstriction. Smoking cessation results in the early elimination of nicotine and carbon monoxide from the system and decreases the risks of ischemia based on these mechanisms. Over the long term, smoking cessation results in elimination of the increased risk of myocardial infarction in patients without previous heart disease as early as 2 years after smoking stops. In addition, for patients with known coronary artery disease, smoking cessation results in an increase in HDL level, which may result in a retardation of atherogenesis and reduced cardiovascular morbidity and mortality. It is important for all physicians to reiterate both the short- and long-term risks of cigarette smoking as well as the good news-that smoking cessation results in a substantial, if not complete, reversal of the risk of myocardial infarction and death, particularly for patients with established coronary artery disease. In light of those established facts, efforts to develop more effective methods to help patients quit smoking must be increased so patients can realize these important health benefits.