The Effects of Cigarette Smoking on the Cardiovascular System: Mechanisms of Damage, Risk Factors, and Prevention Strategies
DOI:
https://doi.org/10.12775/JEHS.2025.77.56630Keywords
cigarettes, tobacco, smoking, cardiovascular diseaseAbstract
Introduction: Cardiovascular diseases remain the leading cause of morbidity and premature mortality. Even though the prevalence of cigarette smoking has decreased over the last few decades, it is still one of the most important preventable risk factors for cardiovascular diseases. Moreover, recently, an increasing number of people have been transitioning to e-cigarettes, which also influence blood pressure and the cardiovascular system.
Purpose of the study: The following review analyzes the association between cigarette smoking and both prevalence and development of cardiovascular diseases. It also suggests the management of tobacco addiction.
Materials and methods: A literature review of English language papers was conducted to summarize the latest knowledge on the topic, focusing on the most recent papers. The review was conducted using the PubMed database, with 53 works used and accessed before December 2024.
Conclusions: Tobacco significantly affects the cardiovascular system, with numerous studies highlighting the negative impacts of both active and passive smoking. Although extensive knowledge exists about tobacco smoke's impact on the cardiovascular system, further research is still needed. A better understanding of the link between smoking and the development of cardiovascular diseases, as well as methods for the management of the addiction, is crucial to developing successful treatment and prevention strategies.
References
Alison Commar (WHO Geneva), Vinayak Prasad (WHO Geneva), Edouard Tursan d’Espaignet (University of Newcastle, Australia). WHO global report on trends in prevalence of tobacco use 2000–2025, fourth edition. ISBN 978-92-4-003932-2 (electronic version). World Health Organization 2021.
Hairong He, Zhenyu Pan, Jiayuan Wu, Chuanyu Hu, Ling Bai, Jun Lyu, Health Effects of Tobacco at the Global, Regional, and National Levels: Results From the 2019 Global Burden of Disease Study, Nicotine & Tobacco Research, Volume 24, Issue 6, June 2022, Pages 864–870, https://doi.org/10.1093/ntr/ntab265
Benowitz, N. L., & Liakoni, E. (2022). Tobacco use disorder and cardiovascular health. Addiction (Abingdon, England), 117(4), 1128–1138. https://doi.org/10.1111/add.15703
Ishida, M., Sakai, C., Kobayashi, Y., & Ishida, T. (2024). Cigarette Smoking and Atherosclerotic Cardiovascular Disease. Journal of atherosclerosis and thrombosis, 31(3), 189–200. https://doi.org/10.5551/jat.RV22015
Mackenbach, J. P., Damhuis, R. A., & Been, J. V. (2017). De gezondheidseffecten van roken [The effects of smoking on health: growth of knowledge reveals even grimmer picture]. Nederlands tijdschrift voor geneeskunde, 160, D869.
Hagstad, S., Bjerg, A., Ekerljung, L., Backman, H., Lindberg, A., Rönmark, E., & Lundbäck, B. (2014). Passive smoking exposure is associated with increased risk of COPD in never smokers. Chest, 145(6), 1298–1304. https://doi.org/10.1378/chest.13-1349
Al Rifai, M., DeFilippis, A. P., McEvoy, J. W., Hall, M. E., Acien, A. N., Jones, M. R., Keith, R., Magid, H. S., Rodriguez, C. J., Barr, G. R., Benjamin, E. J., Robertson, R. M., Bhatnagar, A., & Blaha, M. J. (2017). The relationship between smoking intensity and subclinical cardiovascular injury: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis, 258, 119–130. https://doi.org/10.1016/j.atherosclerosis.2017.01.021
Kaplan, A., Abidi, E., Ghali, R., Booz, G. W., Kobeissy, F., & Zouein, F. A. (2017). Functional, Cellular, and Molecular Remodeling of the Heart under Influence of Oxidative Cigarette Tobacco Smoke. Oxidative medicine and cellular longevity, 2017, 3759186. https://doi.org/10.1155/2017/3759186
Jha, P., Ramasundarahettige, C., Landsman, V., Rostron, B., Thun, M., Anderson, R. N., McAfee, T., & Peto, R. (2013). 21st-century hazards of smoking and benefits of cessation in the United States. The New England journal of medicine, 368(4), 341–350. https://doi.org/10.1056/NEJMsa1211128
Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., Ahmed, M., Aksut, B., Alam, T., Alam, K., Alla, F., Alvis-Guzman, N., Amrock, S., Ansari, H., Ärnlöv, J., Asayesh, H., Atey, T. M., Avila-Burgos, L., Awasthi, A., Banerjee, A., … Murray, C. (2017). Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. Journal of the American College of Cardiology, 70(1), 1–25. https://doi.org/10.1016/j.jacc.2017.04.052
Bhatnagar A. (2004). Cardiovascular pathophysiology of environmental pollutants. American journal of physiology. Heart and circulatory physiology, 286(2), H479–H485. https://doi.org/10.1152/ajpheart.00817.2003
Messner, B., & Bernhard, D. (2014). Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arteriosclerosis, thrombosis, and vascular biology, 34(3), 509–515. https://doi.org/10.1161/ATVBAHA.113.300156
Picciotto, M. R., & Kenny, P. J. (2021). Mechanisms of Nicotine Addiction. Cold Spring Harbor perspectives in medicine, 11(5), a039610. https://doi.org/10.1101/cshperspect.a039610
Toda, N., & Toda, H. (2010). Nitric oxide-mediated blood flow regulation as affected by smoking and nicotine. European journal of pharmacology, 649(1-3), 1–13. https://doi.org/10.1016/j.ejphar.2010.09.042
Nicotine and health. (2014). Drug and therapeutics bulletin, 52(7), 78–81. https://doi.org/10.1136/dtb.2014.7.0264
Centers for Disease Control and Prevention (US), National Center for Chronic Disease Prevention and Health Promotion (US), & Office on Smoking and Health (US). (2010). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Centers for Disease Control and Prevention (US).
Münzel, T., Hahad, O., Kuntic, M., Keaney, J. F., Deanfield, J. E., & Daiber, A. (2020). Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. European heart journal, 41(41), 4057–4070. https://doi.org/10.1093/eurheartj/ehaa460
Walters, M. S., De, B. P., Salit, J., Buro-Auriemma, L. J., Wilson, T., Rogalski, A. M., Lief, L., Hackett, N. R., Staudt, M. R., Tilley, A. E., Harvey, B. G., Kaner, R. J., Mezey, J. G., Ashbridge, B., Moore, M. A., & Crystal, R. G. (2014). Smoking accelerates aging of the small airway epithelium. Respiratory research, 15(1), 94. https://doi.org/10.1186/s12931-014-0094-1
Heitzer, T., Brockhoff, C., Mayer, B., Warnholtz, A., Mollnau, H., Henne, S., Meinertz, T., & Münzel, T. (2000). Tetrahydrobiopterin improves endothelium-dependent vasodilation in chronic smokers : evidence for a dysfunctional nitric oxide synthase. Circulation research, 86(2), E36–E41. https://doi.org/10.1161/01.res.86.2.e36
Celermajer, D. S., Sorensen, K. E., Gooch, V. M., Spiegelhalter, D. J., Miller, O. I., Sullivan, I. D., Lloyd, J. K., & Deanfield, J. E. (1992). Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet (London, England), 340(8828), 1111–1115. https://doi.org/10.1016/0140-6736(92)93147-f
Johnson, H. M., Gossett, L. K., Piper, M. E., Aeschlimann, S. E., Korcarz, C. E., Baker, T. B., Fiore, M. C., & Stein, J. H. (2010). Effects of smoking and smoking cessation on endothelial function: 1-year outcomes from a randomized clinical trial. Journal of the American College of Cardiology, 55(18), 1988–1995. https://doi.org/10.1016/j.jacc.2010.03.002
Otsuka, R., Watanabe, H., Hirata, K., Tokai, K., Muro, T., Yoshiyama, M., Takeuchi, K., & Yoshikawa, J. (2001). Acute effects of passive smoking on the coronary circulation in healthy young adults. JAMA, 286(4), 436–441. https://doi.org/10.1001/jama.286.4.436
Zindel, J., & Kubes, P. (2020). DAMPs, PAMPs, and LAMPs in Immunity and Sterile Inflammation. Annual review of pathology, 15, 493–518. https://doi.org/10.1146/annurev-pathmechdis-012419-032847
Lavi, S., Prasad, A., Yang, E. H., Mathew, V., Simari, R. D., Rihal, C. S., Lerman, L. O., & Lerman, A. (2007). Smoking is associated with epicardial coronary endothelial dysfunction and elevated white blood cell count in patients with chest pain and early coronary artery disease. Circulation, 115(20), 2621–2627. https://doi.org/10.1161/CIRCULATIONAHA.106.641654
Barbieri, S. S., Zacchi, E., Amadio, P., Gianellini, S., Mussoni, L., Weksler, B. B., & Tremoli, E. (2011). Cytokines present in smokers' serum interact with smoke components to enhance endothelial dysfunction. Cardiovascular research, 90(3), 475–483. https://doi.org/10.1093/cvr/cvr032
Jefferis, B. J., Lowe, G. D., Welsh, P., Rumley, A., Lawlor, D. A., Ebrahim, S., Carson, C., Doig, M., Feyerabend, C., McMeekin, L., Wannamethee, S. G., Cook, D. G., & Whincup, P. H. (2010). Secondhand smoke (SHS) exposure is associated with circulating markers of inflammation and endothelial function in adult men and women. Atherosclerosis, 208(2), 550–556. https://doi.org/10.1016/j.atherosclerosis.2009.07.044
Hioki, H., Aoki, N., Kawano, K., Homori, M., Hasumura, Y., Yasumura, T., Maki, A., Yoshino, H., Yanagisawa, A., & Ishikawa, K. (2001). Acute effects of cigarette smoking on platelet-dependent thrombin generation. European heart journal, 22(1), 56–61. https://doi.org/10.1053/euhj.1999.1938
Csordas, A., & Bernhard, D. (2013). The biology behind the atherothrombotic effects of cigarette smoke. Nature reviews. Cardiology, 10(4), 219–230. https://doi.org/10.1038/nrcardio.2013.8
Ichiki, K., Ikeda, H., Haramaki, N., Ueno, T., & Imaizumi, T. (1996). Long-term smoking impairs platelet-derived nitric oxide release. Circulation, 94(12), 3109–3114. https://doi.org/10.1161/01.cir.94.12.3109
Markuljak, I., Ivankova, J., & Kubisz, P. (1995). Thrombomodulin and von Willebrand factor in smokers and during smoking. Nouvelle revue francaise d'hematologie, 37(2), 137–139.
Lippi, G., Franchini, M., & Targher, G. (2011). Arterial thrombus formation in cardiovascular disease. Nature reviews. Cardiology, 8(9), 502–512. https://doi.org/10.1038/nrcardio.2011.91
Ambrose, J. A., & Barua, R. S. (2004). The pathophysiology of cigarette smoking and cardiovascular disease: an update. Journal of the American College of Cardiology, 43(10), 1731–1737. https://doi.org/10.1016/j.jacc.2003.12.047
Cornel, J. H., Becker, R. C., Goodman, S. G., Husted, S., Katus, H., Santoso, A., Steg, G., Storey, R. F., Vintila, M., Sun, J. L., Horrow, J., Wallentin, L., Harrington, R., & James, S. (2012). Prior smoking status, clinical outcomes, and the comparison of ticagrelor with clopidogrel in acute coronary syndromes-insights from the PLATelet inhibition and patient Outcomes (PLATO) trial. American heart journal, 164(3), 334–342.e1. https://doi.org/10.1016/j.ahj.2012.06.005
Alyan, O., Kacmaz, F., Ozdemir, O., Maden, O., Topaloglu, S., Ozbakir, C., Metin, F., Karadede, A., & Ilkay, E. (2008). Effects of cigarette smoking on heart rate variability and plasma N-terminal pro-B-type natriuretic peptide in healthy subjects: is there the relationship between both markers?. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 13(2), 137–144. https://doi.org/10.1111/j.1542-474X.2008.00213.x
Rana, J. S., Moffet, H. H., Liu, J. Y., Nasir, K., Blankstein, R., Karter, A. J., & Sidney, S. (2022). Smoking and Risk of Premature Atherosclerotic Cardiovascular Disease. American journal of preventive medicine, 62(3), 466–468. https://doi.org/10.1016/j.amepre.2021.08.019
Onal, G., Kutlu, O., Gozuacik, D., & Dokmeci Emre, S. (2017). Lipid Droplets in Health and Disease. Lipids in health and disease, 16(1), 128. https://doi.org/10.1186/s12944-017-0521-7
Dinas, P. C., Koutedakis, Y., & Flouris, A. D. (2013). Effects of active and passive tobacco cigarette smoking on heart rate variability. International journal of cardiology, 163(2), 109–115. https://doi.org/10.1016/j.ijcard.2011.10.140
Fountoulakis, P., Theofilis, P., Tsalamandris, S., Antonopoulos, A. S., Tsioufis, P., Toutouzas, K., Oikonomou, E., Tsioufis, K., & Tousoulis, D. (2023). The cardiovascular consequences of electronic cigarette smoking: a narrative review. Expert review of cardiovascular therapy, 21(10), 651–661. https://doi.org/10.1080/14779072.2023.2264179
Rigotti, N. A., & Clair, C. (2013). Managing tobacco use: the neglected cardiovascular disease risk factor. European heart journal, 34(42), 3259–3267. https://doi.org/10.1093/eurheartj/eht352
Burns D. M. (2003). Epidemiology of smoking-induced cardiovascular disease. Progress in cardiovascular diseases, 46(1), 11–29. https://doi.org/10.1016/s0033-0620(03)00079-3
Mandraffino, G., Aragona, C. O., Scuruchi, M., Mamone, F., D'Ascola, A., Alibrandi, A., Cinquegrani, M., Morace, C., Oreto, L., Saitta, C., Mormina, E., Carerj, S., Saitta, A., & Imbalzano, E. (2017). Biglycan expression, earlier vascular damage and pro-atherogenic profile improvement after smoke cessation in young people. Atherosclerosis, 257, 109–115. https://doi.org/10.1016/j.atherosclerosis.2017.01.012
Elwany, S., Shewel, Y., Bazak, R., Talaat, I., & Elwany, M. (2020). Quitting smoking reverses nasal mucosal changes. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 277(6), 1691–1698. https://doi.org/10.1007/s00405-020-05896-x
Taylor, G. M., Lindson, N., Farley, A., Leinberger-Jabari, A., Sawyer, K., Te Water Naudé, R., Theodoulou, A., King, N., Burke, C., & Aveyard, P. (2021). Smoking cessation for improving mental health. The Cochrane database of systematic reviews, 3(3), CD013522. https://doi.org/10.1002/14651858.CD013522.pub2
Seiler-Ramadas, R., Sandner, I., Haider, S., Grabovac, I., & Dorner, T. E. (2021). Health effects of electronic cigarette (ecigarette) use on organ systems and its implications for public health. Wiener klinische Wochenschrift, 133(19-20), 1020–1027. https://doi.org/10.1007/s00508-020-01711-z
Nian, T., Guo, K., Liu, W., Deng, X., Hu, X., Xu, M., E, F., Wang, Z., Song, G., Yang, K., Li, X., & Shang, W. (2023). Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses. BMC medicine, 21(1), 378. https://doi.org/10.1186/s12916-023-03087-z
Cho, E. R., Brill, I. K., Gram, I. T., Brown, P. E., & Jha, P. (2024). Smoking Cessation and Short- and Longer-Term Mortality. NEJM evidence, 3(3), EVIDoa2300272. https://doi.org/10.1056/EVIDoa2300272
Parmar, M. P., Kaur, M., Bhavanam, S., Mulaka, G. S. R., Ishfaq, L., Vempati, R., C, M. F., Kandepi, H. V., Er, R., Sahu, S., & Davalgi, S. (2023). A Systematic Review of the Effects of Smoking on the Cardiovascular System and General Health. Cureus, 15(4), e38073. https://doi.org/10.7759/cureus.38073
Ishida, M., Sakai, C., Kobayashi, Y., & Ishida, T. (2024). Cigarette Smoking and Atherosclerotic Cardiovascular Disease. Journal of atherosclerosis and thrombosis, 31(3), 189–200. https://doi.org/10.5551/jat.RV22015
European Network for Smoking and Tobacco Prevention. 2018 Wytyczne dotyczące leczenia uzależnienia od tytoniu ISBN: 978-618-83869-4-5
Lancaster, T., & Stead, L. F. (2017). Individual behavioural counselling for smoking cessation. The Cochrane database of systematic reviews, 3(3), CD001292. https://doi.org/10.1002/14651858.CD001292.pub3
Lindson, N., Klemperer, E., Hong, B., Ordóñez-Mena, J. M., & Aveyard, P. (2019). Smoking reduction interventions for smoking cessation. The Cochrane database of systematic reviews, 9(9), CD013183. https://doi.org/10.1002/14651858.CD013183.pub2
Prochaska, J. J., & Benowitz, N. L. (2015). Smoking cessation and the cardiovascular patient. Current opinion in cardiology, 30(5), 506–511. https://doi.org/10.1097/HCO.0000000000000204
Cahill, K., Stevens, S., Perera, R., & Lancaster, T. (2013). Pharmacological interventions for smoking cessation: an overview and network meta-analysis. The Cochrane database of systematic reviews, 2013(5), CD009329. https://doi.org/10.1002/14651858.CD009329.pub2
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