Tobacco use and the cardiovascular disease epidemic in developing countries: prevention opportunity

Abstract

Introduction: Cardiovascular diseases remain the leading cause of death in the world, far outstripping deaths due to malaria, Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and tuberculosis. Approximately 80% of the 35 million deaths annually are attributable to chronic diseases and a similar proportion of the approximately 16.7 million deaths due to CVD occur in low and middle income countries. Tobacco use is one of the major avoidable causes of cardiovascular disease. Context and objectives: Smoking is the leading cause of preventable death and is associated with an increased risk of various diseases including cardiovascular disease. The aim of this paper is to review the literature on the role of smoking on cardiovascular disease and effects of anti-smoking legislation on admission due to acute myocardial infarction. Research method/Methodology: PubMed and manual search strategies using the search words ‘tobacco and cardiovascular disease’ were used to identify articles published on the contribution of smoking to cardiovascular events and the effects of legislation. 798 articles were found of which 28 were found useful and 39 were found to be highly relevant for the review. Results: Smoking has been significantly related to acute myocardial infarction (p<0·0001) with an odds ratio of 2·87 (2·36–3·48) for current vs. never, PAR 35·7% for current and former vs. never). Smoking bans have been associated with decreases in instances of acute myocardial infarction ranging from a 40% decrease found in Helena, Montana, USA to an 8% reduction seen in the State of New York. Conclusion: Cardiovascular diseases are a major public health challenge. Smoking plays a major role in cardiovascular pathophysiology. Therefore efforts are required to address the problem especially at preventive level. Public smoking bans are related to fewer admissions for both cardiovascular and respiratory conditions. Legislative efforts to reduce exposure to smoking are needed especially in the developing countries, where prevalence of smoking is rising. Corresponding author: Matheka C. Wambua, Tel: +254726933731, E-mail address: mcw102005@yahoo.co.uk