Patient Recovery Products. EJASTOPLAST*

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AIRSTRIP*

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ICHTHOPASTE*

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PLASTAZOTE*

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SUPER.CRINX* Soft-stretch bandages. DUCHESSE Underpads. CELLOLITE * All cotton-thermal blankets. MINIMS *

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FIAMAZINE*

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NIVEA* Creme Products. ATRIXO* Hand cream and lotion.

Reqistered Trade Mark of Smith & Nephew Ltd.

SMITH & NEPHEW LTD. 2100-52nd Avenue Lachine, Quebec H8T 2Y5 Canada

Cigarette smoking, coronary heart disease and sudden death The medical profession and the public are well aware that cigarette smoking is associated with greatly increased incidence of chronic bronchitis, emphysema and lung cancer. The undesirable effects of smoking on the cardiovascular system are not as well known although they may be more important in terms of the morbidity and mortality that result from accelerated atherosclerosis and its complications. Epidemiologic studies have shown enhancement of coronary heart disease in smokers when compared with nonsmokers.'-3 Among the younger age groups the risk of dying is two to three times greater among cigarette smokers. The total number of deaths attributed to coronary heart disease continues to increase in all developed countries. The principal risk factors are high blood pressure, high serum cholesterol concentration, lack of physical activity, obesity and smoking. The likelihood of coronary heart disease developing is doubled when smoking is associated with any other risk factor. Women are not spared: postmortem data have recently shown that 62% of women dying suddenly of coronary heart disease were heavy smokers and that the mean age at death was 19 years less in the smokers.4 It is suggested that the greater increase in the number of women dying of coronary heart disease, compared with the number of men, can be correlated with the greater increase in heavy smoking among women. Cigarette smokers absorb three times as much nicotine as cigar or pipe smokers.1 There is evidence that nicotine increases platelet aggregation;5 it also increases heart rate, cardiac output, blood pressure and coronary blood flow; and it may predispose to arrhythmia, particularly when the myocardium is damaged. The carbon monoxide content of cigarette smoke is 3 to 6%; carbon monoxide is absorbed by the lungs, and the blood concentration depends on the degree of inhalation. The affinity of hemoglobin for carbon monoxide is 250 times greater than that for oxygen. At equilibrium, 200 parts per million (ppm) of carbon monoxide produces a carboxyhemoglobin concentration of about 20%. The risk for atherosclerotic diseases can be related to blood carboxyhemoglobin (CoHb) values:3 in the age group 30 to 69 years a person with a CoHb value of 5% or more was found to be 21 times as likely to be affected by

these diseases as a person with a lower CoHb value. The threshold for harmful effects of carbon monoxide on myocardium in rabbits has been found to be between 100 and 180 ppm. Toxic changes are manifest in myocardium as focal myofibrillary necrosis with mitochondrial degeneration, and in the aorta as subendothelial edema. In cholesterol-fed rabbits exposed to carbon monoxide for 10 weeks the aortic cholesterol content was 2.5 times higher than that of cholesterol-fed controls.6 Similar observations have been made in monkeys.7'8 Human smokers have higher serum cholesterol, phospholipid and triglyceride values than nonsmokers.9 It is apparent that the combined toxic effects of nicotine and carbon monoxide enhance atherosclerosis and produce cardiomyopathy, which predispose to arrhythmia, coronary insufficiency, thrombosis and sudden death. The Framingham study,2 which has now continued for 18 years, has shown that when men under the age of 65 give up smoking they promptly reduce their risk of coronary heart disease by one half. The knowledge that the risk of sudden death could be almost immediately reduced by 50% should be a strong incentive to stop smoking. Many will smoke no matter what the risks and it is for this reason that the tobacco industry should be encouraged to continue to develop less toxic cigarettes. JOHN LOUGH, MD

Department of pathology The Montreal General Hospital Montreal, P0

References I. The Health Consequences of Smoking, US Public Health Service, 1973 2. GORDON T, KANNEL .B, MCGEE D, et al:

3.

4. 5. 6. 7.

8.

Death and coronary attacks in men after giving up cigarette smoking. Lancet 2: 1345, 1974 WALD N, HOWARD 5, Saum PG, et al: Association between atherosclerotic diseases and carboxyhaemoglobin levels in tobacco smok. ers. Br Med 1 1: 761, 1973 SPAIN DH, SIEGEL H, BRADNEsS VA: Women smokers and sudden death. JAMA 224: 1005, 1973 LEVINE PH: An acute effect of cigarette smoking on platelet function. Circulation 68: 619, 1973 ASTRUP P. KJILD5EN K: Carbon monoxide, smoking and atherosclerosis. Med Clin North Am 58: 323, 1973 WEBSTER WS, CLAIIxsON TB, LOFLAND HB: Carbon monoxide aggravated atherosclerosis in the squirrel monkey. Exp Mol Pathol 13: 36, 1970 THOM5EN HKT: Carbon monoxide-induced atherosclerosis in primates. Atherosclerosis 20: 233, 1974

9. BELLEMORIA JD, POENER H, MET5ELAAR B,

et al: Effects of cigarette smoking on lipids, lipoproteins, blood coagulation, fibrinolysis and cellular components of human blood. Atherosclerosis 21: 61, 1975

CMA JOURNAL/NOVEMBER 22, 1975/VOL. 113

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Cigarette smoking, coronary heart disease and sudden death.

Patient Recovery Products. EJASTOPLAST* Elastic Adhesive Bandages, Dressings & Plasters. AIRSTRIP* Wound and ward dressings. ELASTOCREPE* Crepe el...
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