Rational Pharmacotherapy in Cardiology

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The prevalence of smoking in the Russian Federation is 27.7%. Losses of potential years of life in working age associated with premature death due to smoking in Russia on average are 9 years for men, for women – 5.6 years. Tobacco use is a risk factor for 6 of 8 main causes of death in the world: ischemic heart disease (IHD); cerebral circulation disorders; lower respiratory tract infection; chronic obstructive pulmonary disease; tuberculosis; trachea, bronchus, and lung cancer. The risk of developing IHD in smoking patients is increased by 2-4 times in men and women and in any age group. Myocardial infarction occurs in smoking patients at a younger age, and they have a similar risk of coronary events with patients of older age groups. The increased risk of recurrent coronary events persists with the continuation of smoking in the patient after myocardial infarction. Smoking is associated with a double risk of ischemic stroke and a 2-4-fold increase in the risk of subarachnoid hemorrhage. The risk of peripheral arteries diseases in smokers is increased 3-6 times than this in non-smokers. The mechanisms of development of acute cardiovascular events during smoking include the activation of inflammation, platelet aggregation/thrombogenesis, the sympathetic nervous system, and the development of endothelial dysfunction due to exposure to tobacco smoke components.

About the Authors

O. D. Ostroumova
A.I. Evdokimov Moscow State University of Medicine and Dentistry; I.M. Sechenov First Moscow State Medical University
Russian Federation

Olga D. Ostroumova – MD, PhD, Professor, Chair of Faculty Therapy and Occupational Diseases, A.I. Evdokimov Moscow State University of Medicine and Dentistry; Chair of Clinical Pharmacology and Propaedeutics of Internal Diseases, I.M. Sechenov First Moscow State Medical University

Trubetskaya ul. 8-2, Moscow, 119991

A. A. Izvekov
City Clinical Hospital named after E.O. Mukhin
Russian Federation

Alexander A. Izvekov – MD, PhD, Head Physician 

Federativnii prospekt 17, Moscow, 111399

N. Yu. Voevodina
City Clinical Hospital named after E.O. Mukhin
Russian Federation

Nadezhda Yu. Voevodina – MD, PhD, Deputy Chief Physician on Medical Issues

Federativnii prospekt 17, Moscow, 111399


1. Guidelines for controlling and monitoring the tobacco epidemic. Geneva: World Health Organization; 1998.

2. Gender empowerment and female-to-male smoking prevalence ratios. Available at: Checked by 30.11.2017.

3. Prevalence of tobacco smoking. WHO Global Health Observatory data. Available at: Checked by 30.11.2017.

4. The State Duma ratified the WHO framework convention on tobacco control. Available at: Checked by 30.11.2017. (In Russ.) [Госдума ратифицировала рамочную конвенцию ВОЗ по борьбе против табака. Доступно на: Проверено 30.11.2017].

5. Balanova Yu.A., Kontsevaya A.V., Shalnova S.A., et al. The prevalence of behavioral risk factors for cardiovascular diseases in the Russian population according to the results of the ESSE-RF study. Profilakticheskaja Medicina. 2014;5:42-52. (In Russ.) [Баланова Ю.А., Концевая А.В., Шальнова С.А., и др. Распространенность поведенческих факторов риска сердечнососудистых заболеваний в российской популяции по результатам исследования ЭССЕ-РФ. Профилактическая Медицина. 2014;5:42-52].

6. Comprehensive observation of the living conditions of the population. Federal Service of State Statistics. Available at: Checked by 11/30/2012. (In Russ.) [Комплексное наблюдение условий жизни населения. Федеральная служба государственной статистики. Доступно на: Проверено 30.11.2017].

7. The fate of smokers in Russia. Press Release №2643. VTsIOM Institute. Available at: Checked by 11/30/2012 (In Russ.) [Судьба курильщиков в России. Пресс-выпуск №2643. Институт ВЦИОМ. Доступно на: Проверено 30.11.2017].

8. The Ministry of Health decided to wean Russians from smoking by a ban on the sale of cigarettes. Available at: Checked by 11/30/2012. (In Russ.) [Минздрав решил отучить россиян от курения запретом на продажу сигарет. Доступно на: Проверено 30.11.2017].

9. Global survey of the adult population on the use of tobacco products. Russian Federation, 2009. Country report. Federal Service of State Statistics. Available at: population/zdrav/GATS.doc. Checked by 11/30/2012 (In Russ.) [Глобальный опрос взрослого населения о пользовании табачными изделиями. Российская Федерация, 2009 г. Страновой отчет. Федеральная служба государственной статистики. Доступно на: Проверено 30.11.2017].

10. Mathers C.D., Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PloSMedicine. 2006;3(11):e442. doi: 10.1371/journal.pmed.0030442.

11. The health consequences of smoking 50 years of progress: a report of the Surgeon General, 2014. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA. Available at: . Checked by 30.11.2017.

12. How Tobacco Smoke Causes Disease: What It Means to You [Электронный ресурс] // U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Available at: Checked by 30.11.2017.

13. Centers for Disease Control and Prevention. QuickStats: Number of Deaths from 10 Leading Causes National Vital Statistics System, United States, 2010. Morbidity and Mortality Weekly Report. 2013:62(08);155.

14. Mokdad A.H., Marks J.S., Stroup D.F., Gerberding J.L. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-45. doi:10.1001/jama.291.10.1238.

15. Hasdai D., Garratt K.N., Grill D.E., et al. Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. N Engl J Med. 1997;336(11):755-61. doi: 10.1056/NEJM199703133361103.

16. Wannamethee G., Shaper A.G., Macfarlane P.W., Walker M. Risk factors for sudden cardiac death in middle-aged British men. Circulation. 1995;91(6):1749-56. doi: 10.1161/01.CIR.91.6.1749.

17. Goldstein L.B., Adams R., Alberts M.J., et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council. Stroke 2006;37:1583133. doi: 10.1161/01.STR.0000223048.70103.F1

18. Howard G., Wagenknecht L.E., Burke G.L, et al. Cigarette Smoking and Progression of Atherosclerosis The Atherosclerosis Risk in Communities (ARIC) Study. JAMA 1998;279(2):119-24. doi:10.1001/jama.279.2.119

19. Colditz G.A., Bonita R., Stampfer M.J., et al. Cigarette Smoking and Risk of Stroke in Middle-Aged Women. N Engl J Med. 1988;318:937-41. doi: 10.1056/NEJM198804143181501.

20. Kurth T., Kase C.S, Berger K., et al. Smoking and risk of hemorrhagic stroke in women. Stroke. 2003;34(12):2792-5. doi: 10.1161/01.STR.0000100165.36466.95.

21. Hart C.L., Hole D.J., Smith G.D. Risk factors and 20-year stroke mortality in men and women in the Renfrew/Paisley study in Scotland. Stroke. 1999;30(10):1999-2007. doi: 10.1161/01.STR.30.10.1999.

22. Hankey G.J., Norman P.E., Eikelboom J.W. Medical treatment of peripheral arterial disease. JAMA. 2006;295(5):547-53. doi:10.1001/jama.295.5.547.

23. Hooi J.D., Kester A.D, Stoffers H.E., et al. Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study. Am J Epidemiol. 2001;153(7):666-72.

24. Vardulaki K.A., Walker N.M., Day N.E., et al. Quantifying the risks of hypertension, age, sex and smoking in patients with abdominal aortic aneurysm. Br J Surg. 2000;87(2):195-200. doi: 10.1046/j.1365-2168.2000.01353.x.

25. Criqui M.H. Peripheral arterial disease--epidemiological aspects. Vasc Med. 2001;6(3 Suppl):3-7. doi: 10.1177/1358836X0100600i102.

26. Pujades-Rodriguez M., George J., Shah A.D., et al. Heterogeneous associations between smoking and a wide range of initial presentations of cardiovascular disease in 1 937 360 people in England: lifetime risks and implications for risk prediction. International Journal of Epidemiology. 2015;44(1):129–41. doi: 10.1093/ije/dyu218.

27. Tolstrup J.S., Hvidtfeldt U.A., Flachs E.M., et al. Smoking and risk of coronary heart disease in younger, middle-aged, and older adults. Am J Public Health. 2014;104(1):96-102. doi: 10.2105/AJPH.2012.301091.

28. Menotti A., Lanti M., Nedeljkovic S., et al. The relationship of age, blood pressure, serum cholesterol and smoking habits with the risk of typical and atypical coronary heart disease death in the European cohorts of the Seven Countries Study. Int J Cardiol. 2006;106(2):157-63. doi: 10.1016/j.ijcard.2004.12.092.

29. Yusuf S., Hawken S., Ounpuu S., et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (The INTERHEART study). Lancet. 2004; 364(9438):937– 52. doi: 10.1016/S0140-6736(04)17018-9.

30. Howe M., Leidal A., Montgomery D., Jackson E. Role of cigarette smoking and gender in acute coronary syndrome events. Am J Cardiol. 2011;108(10):1382-6. doi: 10.1016/j.amjcard.2011.06.059.

31. Wakabayashi K., Romaguera R., Laynez-Carnicero A., et al. Impact of smoking on acute phase outcomes of myocardial infarction. Coron Artery Dis. 2011;22(4):217-22. doi: 10.1097/MCA.0b013e3283441d28.

32. Himbert D., Klutman M., Steg G., et al.; GRACE Investigators. Cigarette smoking and acute coronary syndromes: a multinational observational study. Int J Cardiol. 2005;100(1):109-17. doi: 10.1016/j.ijcard.2004.10.004.

33. Weisz G., Cox D.A., Garcia E., et al. Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction--the smoker's paradox revisited. Am Heart J. 2005;150(2):358-64. doi: 10.1016/j.ahj.2004.01.032.

34. Kruk M., Pregowski J., Mintz G.S., et al. Intravascular ultrasonic study of gender differences in ruptured coronary plaque morphology and its associated clinical presentation. Am J Cardiol. 2007;100(2):185-9. doi: 10.1016/j.amjcard.2007.02.084.

35. Kim S.G., Apple S., Mintz G.S., et al. The importance of gender on coronary artery size:in-vivo assessment by intravascular ultrasound. Clin Cardiol. 2004;27:291–4. doi: 10.1002/clc.4960270511.

36. Back S.E., Waldrop A.E., Saladin M.E., et al. Effects of gender and cigarette smoking on reactivity to psychological and pharmacological stress provocation. Psychoneuroendocrinology. 2008;33(5):5608. doi: 10.1016/j.psyneuen.2008.01.012.

37. Rea T.D., Heckbert S.R., Kaplan R.C., et al. Smoking status and risk for recurrent coronary events after myocardial infarction. Ann Intern Med. 2002;137(6):494-500. doi: 10.7326/0003-4819-1376-200209170-00009.

38. Turan A., Mascha E.J., Roberman D., et al. Smoking and perioperative outcomes. Anesthesiology. 2011;114(4):837-46. doi: 10.1097/ALN.0b013e318210f560.

39. Zhang Y.J., Iqbal J., van Klaveren D., et al. Smoking is associated with adverse clinical outcomes in patients undergoing revascularization with PCI or CABG: the SYNTAX trial at 5-year follow-up. J Am Coll Cardiol. 2015;65(11):1107-15. doi: 10.1016/j.jacc.2015.01.014.

40. Benowitz N.L., Burbank A.D. Cardiovascular toxicity of nicotine: Implications for electronic cigarette use. Trends Cardiovasc Med. 2016;26(6):515-23. doi:10.1016/j.tcm.2016.03.001.

41. Gupta R., Gurm H., Bartholomew J.R. Smokeless tobacco and cardiovascular risk. Arch Intern Med. 2004;164(17):1845-9. doi: 10.1001/archinte.164.17.1845.

42. Yanbaeva D.G., Dentener M.A., Creutzberg E.C., et al. Systemic effects of smoking. Chest. 2007;131(5):1557-66. doi: 10.1378/chest.06-2179.

43. Todua F.I., Gachechiladze D.G., Balavadze N.B., Ahvelediane M.V. Influence of a number of atherogenic risk factors on the state of the intima media complex of the common carotid artery. Kardiologiia. 2003;3:50-3. (In Russ.) [Тодуа Ф.И., Гачечиладзе Д.Г., Балавадзе Н.Б., Ахвеледиане М.В. Влияние ряда атерогенных факторов риска на состояние комплекса интима-медиа общей сонной артерии. Кардиология. 2003;3:50-3].

44. Oganov R.G. Primary prophylaxis of ischemic heart disease. Moscow: Meditsina; 1990 (In Russ.) [Оганов Р.Г. Первичная профилактика ишемической болезни сердца. М.: Медицина; 1990].

45. Muscat J.E., Harris R.E., Haley N.J., Wynder E.L. Cigarette smoking and plasma cholesterol. Am Heart J. 1991;121(1 Pt 1):141-7. doi: 10.1016/0002-8703(91)90967-M.

46. Petruzzelli S., Hietanen E., Bartsch H., et al. Pulmonary lipid peroxidation in cigarette smokers and lung cancer patients. Chest. 1990;98(4):930-5. doi: 10.1378/chest.98.4.930.

47. Harrats D., Ben-Naim M., Debach Y. Cigarette smoking renders LDL susceptible to peroxidative modification and enhanced metabolism by macrophages. Atherosclerosis. 1989;79(2-3):245-52. doi: 10.1016/0021-9150(89)90130-5.

48. Syrkin A., Novikova N., Horustovich N. Features of coronary heart disease in young. Vrach. 2001; 4: 5-8 (In Russ.) [Сыркин А., Новикова Н., Горустович Н. Особенности ишемической болезни сердца у молодых. Врач. 2001;4:5-8].

49. Catapano A.L., Graham I., De Backer G., et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016;253:281-344. doi: 10.1016/j.atherosclerosis.2016.08.018.

50. Groppelli A., Omboni S., Parati G., Mancia G. Blood pressure and heart rate response to repeated smoking before and after beta-blockade and selective alpha 1 inhibition. J Hypertens Suppl. 1990;8(5):S35-40.

51. Grassi G., Seravalle G., Calhoun D.A, et al. Mechanisms responsible for sympathetic activation by cigarette smoking in humans. Circulation. 1994;90(1):248-53. doi: 10.1161/01.CIR.90.1.248.

52. Mancia G., Groppelli A., Di Rienzo M., et al. Smoking impairs baroreflex sensitivity in humans. Am J Physiol. 1997;273(3 Pt 2):H1555-60.

53. Primatesta P., Falaschetti E., Gupta S., et al. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension. 2001;37(2):187-93. doi: 10.1161/01.HYP.37.2.187.

54. Groppelli A., Giorgi D.M., Omboni S., et al. Persistent blood pressure increase induced by heavy smoking. J Hypertens. 1992;10:495–9.

55. Mann S.J., James G.D., Wang R.S., Pickering T.G. Elevation of ambulatory systolic blood pressure in hypertensive smokers. A case-control study. JAMA. 1991;265(17):2226-8. doi: 10.1001/jama.1991.03460170080037.

56. Mancia G., Fagard R., Narkiewicz K., et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281-357. doi: 10.1097/

57. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78. doi: 10.1093/europace/euw295.

58. Chamberlain A.M., Agarwal S.K., Folsom A.R., et al. Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm. 2011;8(8):11606. doi: 10.1016/j.hrthm.2011.03.038.

59. O'Donnell M.J., Xavier D., Liu L., et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112-23. doi: 10.1016/S0140-6736(10)60834-3.

60. Feigin V., Parag V., Lawes C.M., et al. Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants. Stroke. 2005;36(7):1360-5. 0000170710.95689.41.

61. Feigin V.L., Rinkel G.J., Lawes C.M., et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36(12):2773-80. 01.STR.0000190838.02954.e8.

62. Kurth T., Kase C.S., Berger K., et al. Smoking and the risk of hemorrhagic stroke in men. Stroke. 2003;34(5):1151-5.

63. Feldmann E., Broderick J.P., Kernan W.N., et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke. 2005;36(9):1881-5. 62341.6b.

64. Peters S.A., Huxley R.R., Woodward M. Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes. Stroke. 2013;44(10):2821-8. doi: 10.1161/STROKEAHA.113.002342.

65. Thun M.J., Apicella L.F., Henley S.J. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. JAMA. 2000;284(6):706-12. doi:10.1001/jama.284. 6.706.

66. Smoking-attributable mortality, years of potential life lost, and productivity losses–United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008;57(45);1226-8.

67. Nakamura K., Barzi F., Lam T.H., et al. Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the Asia-Pacific region. Stroke. 2008;39(6):1694-702. doi: 10.1161/ STROKEAHA.107.496752.

68. Ischaemic stroke and combined oral contraceptives: results of an international, multicentre, casecontrol study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1996;348(9026):498-505.

69. Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1996;348(9026):505-10.

70. Pezzini A., Grassi M., Del Zotto E., et al. Synergistic effect of apolipoprotein E polymorphisms and cigarette smoking on risk of ischemic stroke in young adults. Stroke. 2004;35(2):438-42.

71. Burns D.M. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis. 2003;46(1):11-29.

72. Kool M.J., Hoeks A.P., Struijker Boudier H.A., et al. Shortand long-term effects of smoking on arterial wall properties in habitual smokers. J Am Coll Cardiol. 1993;22(7):1881-6.

73. Silvestrini M., Troisi E., Matteis M., et al. Effect of smoking on cerebrovascular reactivity. J Cereb Blood Flow Metab. 1996 Jul;16(4):746-9. doi: 10.1097/00004647-199607000-00027.

74. Karttunen V., Alfthan G., Hiltunen L., et al. Risk factors for cryptogenic ischaemic stroke. Eur J Neurol. 2002;9(6):625-32.

75. Goldstein L.B., Bushnell C.D., Adams R.J., et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(2):517-84. doi: 10.1161/STR.0b013e3181fcb238.

76. Agarwal S. The association of active and passive smoking with peripheral arterial disease: results from NHANES 1999-2004. Angiology. 2009;60(3):335-45. doi: 10.1177/0003319708330526.

77. Meyers D.G., Neuberger J.S., He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54(14):1249-55. doi: 10.1016/j.jacc.2009.07.022.

78. Lu L., Mackay D.F., Pell J.P. Meta-analysis of the association between cigarette smoking and peripheral arterial disease. Heart. 2014;100(5):414-23. doi: 10.1136/heartjnl-2013-304082. doi: 10.1136/heartjnl-2013-304082.

79. Gerhard-Herman M.D., Gornik H.L., Barrett C., et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12):e686-e725. doi: 10.1161/CIR.0000000000000470.


For citations:

Ostroumova O.D., Izvekov A.A., Voevodina N.Yu. SMOKING AS A RISK FACTOR OF CARDIOVASCULAR AND CEREBROVASCULAR DISEASES: PREVALENCE, IMPACT ON PROGNOSIS, POSSIBLE SMOKING CESSATION STRATEGIES AND THEIR EFFECTIVENESS. Part 1. Smoking Prevalence and Impact on Prognosis. Rational Pharmacotherapy in Cardiology. 2017;13(6):871-879. (In Russ.)

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