Dr. Bernard Leech of Conemaugh Family Medicine Center has been known to ask patients if he can prescribe medicine that costs $7 a day and causes shortness of breath, raises blood pressure and heart rate, reduces oxygen levels, contains cancer-causing chemicals and will ultimately cause death.
When patients balk, he points out that he just described their smoking habit.
Although smoking is often associated with an increased risk of cancer, tobacco is also the No. 1 risk factor for heart disease.
“Cigarettes increase your risk of atherosclerosis,” Dr. Jeanne Spencer, Memorial Medical Center family medicine residency program director said at the Family Medicine Center.
Atherosclerosis refers to the buildup of fats as plaque on artery walls. Atherosclerosis in the arteries of the heart can lead to heart attacks.
“Nicotine causes vasoconstriction, which is when the blood vessels spasm and close down a bit,” Spencer said. “If they tighten down when they are already narrowed (by atherosclerosis), you are in bigger trouble.”
Smoking also increases the heart rate, but cuts down on the amount of oxygen pushing carbon monoxide and other waste materials into the bloodstream, said Michelle George, Memorial’s tobacco cessation/prevention program coordinator.
And while the local medical experts stress the hazards of tobacco use, they understand the challenge quitting presents.
‘Dependency triangle’
In 1988, a report by Surgeon General C. Everett Koop compared characteristics of tobacco addiction to heroin and cocaine addiction.
“It is never going to be easy,” Leech said. “Ultimately, it boils down to empowering the individual to make that change. Our job is to assist them to that goal.”
George says there are three aspects to the smoking addiction: Nicotine addiction, habit and emotion. Successful quitters have to break free from all three sides of the dependency triangle.
Nicotine replacement therapy can help ease quitters through the withdrawal, she added.
The second issue is breaking the smoking habit, which requires changes in routine, George said.
“When do you smoke?” she asks. “When you get up in the morning? When you’re driving a car? You can modify your life-style. Take your coffee back to the bedroom and read the paper.”
Spencer put it this way:
“Try to change the routine.
“Don’t sit in your smoking chair at smoking time and think you are not going to smoke.”
The third area, emotional dependency, also requires a change in routine. Smokers often light up when they feel stressed.
“See what you can do in place of going out and having that cigarette,” George said.
‘Ready to quit’
Memorial and Somerset Hospital each offer tobacco cessation classes that encourage participants to quit smoking by showing the health benefits and offering strategies for success.
Tools include nicotine replacement products such as patches and chewing gum.
But a study published last month in the scientific journal Tobacco Control casts some doubt on the value of replacement therapy.
The study by Harvard Medical School’s Center for Global Tobacco Control and the University of Massachusetts found those using the replacement therapy were just as likely to relapse as those who quit “cold turkey.”
Local cessation advocates believe more study is needed and continue to suggest nicotine replacement as a tool.
“It helps get them through that relapse,” George said. “The patches help them not have as severe withdrawal symptoms. But they have to be ready to quit.”
Dr. Matthew Masiello, director of the Center for Health Promotion and Disease Prevention at Windber Research Institute, said the study and the patches illustrate misconceptions.
“We have to put it into context,” Masiello said. “There has to be a level of education accessible to use the products effectively. These patches will work if you use them effectively.
“These studies tell us we have to stop thinking that the product is going to be it for us. You need to be working toward the optimal environment. You can’t think the product is going to change all of your environment.”
The experts had several tips they like to share with smokers who want to quit.
George and Spencer both urge smokers to set a quit date.
As the date approaches, remove ashtrays and stashes of tobacco from the house.
“Getting people around you to quit helps a lot,” Leech said.
“That way you are not exposed to it.”
Above all, be committed, Spencer said.
“Most people try three times before they actually quit,” she said. “If they fail on the first try, we tell them to just do it again.”
‘Learn and live’
Masiello’s tobacco-prevention advice took a different direction.
“Get a high school education,” Masiello said. “I know that sounds absurd, but we have seen the research: The higher education level you obtain, the better you are going to take care of yourself.
“We need to do a better job of keeping kids in high school.”
It won’t be long before many Americans have additional incentives to quit, Masiello predicts.
“Businesses are going to stop hiring smokers,” he said. “We now see 80 percent of the people don’t smoke.”
Employees who smoke drive up a company’s health-care costs and increase absenteeism, he said.
Masiello applauded Geisinger Health Care system’s new policy to stop hiring tobacco users, as of Feb. 1.
All job applicants – including full-time and part-time positions, volunteers and students enrolled in the system’s schools – are now required to complete urine testing.
Geisinger is not the first company to adopt a similar policy, which is legal in 20 states.
More employers are bound to join the cause, Masiello said.
“You are not affecting people’s rights,” he said. “You are helping them get healthy.”
**This article was published in the Tribune Democrat on 2/18/12
http://tribune-democrat.com/local/x1265287779/Heart-health-Smoking-a-prime-heart-disease-culprit
Prevention of heart disease begins young, experts say, encouraging parents to instill proven nutrition and exercise lifestyles from infancy.
Matt Masiello, M.D., MPH 