Tobacco The totally avoidable risk factor of cardiovascular disease. Dr Vash Mungal-Singh

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1 Tobacco The totally avoidable risk factor of cardiovascular disease Dr Vash Mungal-Singh WNTD Workshop 26 May 2015

2 Overview Burden of cardiovascular disease in South Africa Tobacco as a risk factor for cardiovascular disease Tobacco and CVD in women Second-hand smoke and CVD Benefits of quitting

3 What is CVD? Disorders of the circulatory system, affecting the heart and blood vessels Usually arises as a result of atherosclerosis Ooooo Interfere with blood supply to the body, and can lead to heart attacks, strokes, peripheral vascular disease and many other conditions Global causes of death Ooo Oo

4 Heart disease and strokes in SA What does the picture look like in South Africa?

5 Heart disease and strokes in SA 2 Heart disease & strokes are the 2 nd biggest cause of death after HIV/AIDS

6 Heart disease and strokes in SA Every hour: 5 heart attacks 10 strokes

7 Blood Heart pressure disease and strokes heart disease in SA 1 in 6 people in South Africa will die from heart disease or stroke

8 Heart disease and strokes in SA Half of people dying from heart disease are younger than 70 years old

9 (INTERHEART, Yusuf et al, Lancet 2004) Modifiable risks for heart attack Exercise 16% Fruit & veg 30% Obesity 162% Hypertension 191% Diabetes 237% Smoking 287% Cholesterol 325%

10 Modifiable risks for stroke Exercise 30% Unhealthy diet 135% Diabetes 136% > 1 alcoholic drink/day 151% Obesity 165% Cholesterol 189% Smoking 209% (INTERSTROKE, O Donnell, Lancet 2010) Hypertension 264%

11 Blood pressure The good and news! heart disease We can prevent 80% of premature deaths from cardiovascular disease with healthy living

12 Tobacco kills!!! Single largest preventable cause of death (avoidable) Worldwide, tobacco use responsible for 6 million deaths every year Prime factor in heart disease, stroke and chronic lung disease, cancer Many people don t link smoking to heart disease, and believe the major risk of smoking is lung cancer Responsible for a fifth of CVD worldwide

13 Most deaths from tobacco due to (Groenewald, SAMJ, 2007)

14 Smoking prevalence 1 in 5 adults in South Africa smoke 1 in 5 grade 8 to 11 learners smoke tobacco, and 7% start smoking under 10 years of age Legislation has led to a significant drop in smoking prevalence, but still too many people smoke (SANHANES-1, 2013; YRBS, 2008)

15 Tobacco use increases risk for CVD Increases risk of dying from heart disease/stroke 2-3 fold Greater risk if started younger & in heavy smokers Other forms of tobacco also increase risk (WHO Global Atlas, 2011)

16 How does tobacco cause CVD? Accelerates atherosclerosis Damages inner lining of blood vessels Increases plaques (fatty deposits) Raises bad LDL cholesterol & decreases good HDL cholesterol Increases blood clotting Nicotine accelerates heart rate & increases blood pressure Carbon monoxide reduces oxygen in the blood

17 Atherosclerosis

19 Stroke

20 Peripheral Vascular Disease

21 Tobacco and CVD in women Women who smoke are at higher risk of heart attacks & stroke than men who smoke Women: 3-5 cigarettes/day double their risk Men: 6-9 cigarettes/day double their risk (WHO Global Atlas, 2011)

22 Oral contraceptives and smoking For healthy young women, oral contraceptives usually safe However, in women who smoke, risk of heart attack, stroke & peripheral vascular disease is drastically increased All women who use oral contraceptives should be informed of these risks & encouraged not to smoke

23 Menopause and smoking At a younger age, risk for CVD lower in women than men, but risk increases to similar level as men during menopause Women taking hormone replacement therapy have an increased risk for thrombosis Risk of thrombosis further increased with smoking

24 Second-hand smoke & CVD Breathing in smoke from tobacco products used by others Exposed to many of the same harmful chemicals as smokers themselves Despite prohibitions on smoking in public places, many children, women and men are exposed to second-hand smoke 23% of youth exposed to second-hand smoke in their homes 29.9 % of adults exposed to secondhand smoke (SANHANES-1, 2013; Tobacco Atlas, 2014)

Second-hand smoke & CVD Second-hand smoke kills 600 000 people each year 28% are children Non-smokers exposed to second-hand smoke increase their

25 Second-hand smoke & CVD Second-hand smoke kills people each year 28% are children Non-smokers exposed to second-hand smoke increase their heart disease & stroke risk by 25-30% Other risks for children: Ear infections Asthma, respiratory problems Chest infections Sudden infant death syndrome

Health benefits after quitting 24 hours Lungs clear mucus 12 hours Blood pressure drops Circulation improves 48 hours No nicotine left in your body Sense of taste & smell improves Breath, hair &

26 Health benefits after quitting 24 hours Lungs clear mucus 12 hours Blood pressure drops Circulation improves 48 hours No nicotine left in your body Sense of taste & smell improves Breath, hair & teeth cleaner 3 days Breathing easier Within 10 years Risk of lung cancer halved Within 5 years Risk of heart disease & stroke is almost identical to a non-smoker Within 1 year Risk of heart attack falls by half 3 months Tiny hairs in lungs grow Phlegm & tar removed 2-12 weeks Lung function improves More energy & exercise is easier

be devastating But quitting has substantial benefits to health

27 Take home messages The public may not be aware that smoking is linked to heart disease and strokes The effects of smoking can be devastating But quitting has substantial benefits to health Educate your clients about the dangers of smoking, particularly women

For more information: Visit www.heartfoundation.co.

28 For more information: Visit Phone Heart and Stroke Health line on HEART (43278) heart@heartfoundation.co.za

Because we care about your health

Because we care about your health Contact us For information on Trust services see www.awp.nhs.uk PALS To make a comment, raise a concern or make a complaint, please contact the Trust s Patient Advice and Liaison Service (PALS). Smoking