CIGARETTE smoking is an important cause of early death and chronic disease. In fact, smoking is the most important cause of preventable early mortality worldwide.

Aside from early death, smoking is associated with the increased risk of lung disease, heart disease and cancers of various types including lung, head and neck, kidney, and breast. It is also associated with an increased incidence of male infertility, osteoporosis, infections, diabetes, and kidney disease. Unfortunately, in Jamaica we have the second highest incidence of smoking in the English-speaking Caribbean with 17 per cent of adults smoking, according to data from the World Health Organization. Aside from the health consequences of smoking, given its addictive nature, smokers in Jamaica spend a significant amount of their yearly income on cigarettes. As physicians, whenever we encounter a patient who is a current smoker, we advise that they discontinue cigarette smoking as there are multiple health benefits to be obtained. Many studies have demonstrated these improvements in health outcomes and importantly there does not appear to be an age at which stopping smoking is not associated with improved health.

The challenge for most smokers is then how to stop cigarette smoking as this activity is addictive. A common meme is that the easiest way to stop smoking is never to have started. We have made some progress in helping patients who are ready to quit smoking improve the odds of success. Nonetheless most people who are able to quit have tried and failed on multiple occasions. The ideal goal for most patients should be to stop smoking altogether as opposed to a reduction in the number of cigarettes smoked. It is true to say that reducing the number of cigarettes smoked does reduce the risk of some conditions eg, chronic obstructive lung disease and some cancers. However, for cardiac and vascular disease it is really all or none, as several studies have demonstrated the increased risk in non-smokers who are exposed to second-hand smoke.

Am I ready to stop smoking?

Probably the most important factor in successfully quitting cigarettes is the readiness of the smoker to stop. For the most part, until a patient is ready to stop there is not much that health-care personnel can do. There is some data that suggests that asking about smoking habits and counselling smoking cessation does have a small effect, so that for many physicians this is a routine part of practice. Given the additive nature of cigarettes it can be difficult for patients to find the willpower to stop smoking. For some patients, having a cardiac or vascular complication associated with cigarette smoking can improve the chance that they will quit. The percentage of smokers that stop smoking after a heart attack varies in different studies but can be as high as 40-50 per cent of patients. Studies have further demonstrated a 50 per cent reduction in the risk of subsequent heart attack if a patient can successfully discontinue the use of cigarettes. An important advantage that the hospitalised patient has is that they are forced to stop smoking while they are hospitalised and are commonly prescribed medication to reduce nicotine cravings and withdrawal symptoms.

What will happen when I stop?

Stopping cigarettes does make the smoker feel unwell because there are effects that occur secondary to nicotine withdrawal and effects that are related to psychological and physiological changes in the brain. Symptoms of nicotine withdrawal start almost immediately, peak about three to four days after smoking cessation and can last for about three to four weeks. These symptoms include difficulty sleeping, anxiety, constipation, mood changes and trouble thinking clearly. Nicotine replacement therapy can help reduce these symptoms. Weight gain is a common long-term consequence of stopping smoking with the average weight gain being 8 to 10 pounds. This does appear to be associated with increased food/caloric intake after smoking cessation. The issue of cravings or the psychological need to have a cigarette can persist for years after stopping and while medication can help some, some patients will tell us that these sensations/cravings never really go away.

Are there ways to reduce the symptoms

Nicotine replacement therapy is generally short-term therapy that is designed to replace the nicotine that was obtained from the cigarette with nicotine that enters the body without the accompanying toxins that are produced by combustion of the cigarette leaf. There are several forms including gum, patches, nasal sprays, and lozenges. As a general rule the higher the number of cigarettes that are smoked on a daily basis is the higher the amount of nicotine that is needed initially. For most people nicotine replacement therapy is only necessary for a few weeks to few months after smoking cessation. Aside from nicotine replacement therapy there are some medications which are useful. Varenicline (Chantix) is a medication that both reduces nicotine withdrawal symptoms and also helps with symptoms of craving cigarettes. Bupropion (Wellbutrin) has also been shown to help with cigarette cravings.

Next week we will look at how to stop smoking.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.