Page 511 - Encyclopedia of Nursing Research

478 n SmOKIng/TOBACCO AS A CARDIOVASCUlAR RISK FACTOR

2010). Smoking is highest in non-hispanic disease (lu & Creager, 2004). Smoking
American Indians or Alaska natives, and adversely affects the following: (1) endothe-
S lowest in non-hispanic Asians. The preva- lial system, (2) lipoprotein metabolism, (3)
lence of smoking varies considerably from blood coagulation, (4) platelets, and (5) oxy-
state to state and is highest in West Virginia gen supply and demand (miller, 2008).
(26.5%) and lowest in Utah (9.3%) (Centers The hazardous effects of smoking are
for Disease Control, 2009). Smoking prev- also found for those exposed to tobacco.
alence is highly dependent on the success nonsmokers exposed to environmental
of tobacco-related legislation and policies tobacco smoke suffer an increased 30% risk
within states and is often higher in states of developing ischemic heart disease. On
where tobacco is grown. Although the time the basis of measurements of urinary coti-
of initiation of smoking is 14 to 15 years, nine, the national Research Council (1986)
the percentage of students ever trying ciga- estimates that environmental tobacco expo-
rettes declined from 70.4% in 1999 to 50.3% sure is equivalent to actively smoking 0.1 to
in 2007 (American heart Association, 2010). 1.0 cigarettes per day. An estimated 35,000
prevention strategies within schools and ischemic heart disease deaths annually are
a greater focus on tobacco legislation have believed to be due to the effects of environ-
likely led to this decline. mental tobacco exposure which includes
Smoking affects almost every tissue and both sidestream (burning cigarettes) and
organ in the body and is associated with high mainstream (smokers’ exhalation) smoke
rates of common diseases such as chronic (glantz & parmley, 1991).
obstructive pulmonary disease, most can- Smoking also imposes a significant social
cers, and cardiovascular disease. Smoking burden due to the high costs of tobacco-
is a major risk factor for coronary heart dis- related illnesses. The health care expendi-
ease, peripheral vascular disease, aortic tures associated with smoking are estimated
aneurysm, and stroke. The relative risks are at $96 billion in direct medical costs and $97
greatest for those with peripheral vascular billion in lost productivity (American heart
disease and lowest for stroke, with interme- Association, 2010).
diate relative risks in those with coronary In 2008, the U.S. Department of health
heart disease and aortic aneurysm. In addi- and human Services updated the Clinical
tion, smoking increases the risk of coronary practice guideline on Treating Tobacco Use
thrombosis and sudden cardiac death. The and Dependence. published initially in 1996,
risk of coronary heart disease, the leading the guideline reviewed over 8,700 studies on
cause of death in those less than 45, relates smoking conducted from 1975 to 2007. On the
to all levels of cigarette smoking, including basis of strong evidence from randomized
those individuals smoking less than 5 ciga- controlled trials, this guideline recommends
rettes per day (Burns, 2003). Finally, smoking the following: (1) brief interventions of 3 min-
reduces the life span of males by 13.2 years utes are recommended for all current smok-
and of women by 14.5 years (American heart ers, those unwilling to make an attempt,
Association, 2010). and former smokers who have recently quit;
Smoking has important adverse path- (2) both pharmacotherapies and behavioral
ophysiological effects on the vascular sys- counseling work best when combined; (3) the
tem. most of the toxic effects of smoking are 5 “A’s” of asking about smoking, advising to
found in the 4,000 compounds in cigarettes. quit, assessing willingness to quit, assisting
Although carbon monoxide and nicotine are those ready to make an attempt, and arrang-
often thought to be the worst culprits asso- ing for follow-up continue to be advocated;
ciated with smoking, toxins cause damage (4) medications should be offered to every-
along different pathways leading to vascular one except those populations with lack of