While the government can resort to punitive methods or declare substances as illicit, the best strategy is to improve our health education, recommends Dr (Col) Anil Dhall, Director of Cardiovascular Sciences at Venkateshwar Hospital here.
Awareness of the risks of smoking is undoubtedly an important public health message, because it potentially allows targeted intervention — especially to younger smokers — with consequent reductions in mortality and morbidity, the doctor asserts.
Compared with people who have quit or never smoked, current smokers face a significantly higher chance of developing heart attacks, and as striking new data show, the risk from smoking appears to be greatest in the young individuals.
The numbers highlight the importance of increasing public health messages about the cardiovascular risks associated with tobacco use rather than focusing primarily on lung disease, said Dhall citing researches.
Smokers currently have only a vague understanding of the increased risk of an acute myocardial infarction (MI) that smoking confers, and presented as a numerical hazard, smokers may find it more difficult to ignore, he said.
In a recent study, compared with former and never-smokers, current smokers of all ages had triple the risk of heart attacks. Smokers who were younger than age 50 had the worst discrepancy in risk of all — more than eight times that of former and never-smokers.
Those who were 50-65 years of age had more than five times the risk of heart attacks, and those over age 65 years had more than three times the risk compared with similarly aged persons who did not currently smoke.
Importantly, rates of heart attacks and age at presentation between former and never-smokers are comparable, confirming suggestions from other, larger studies that “giving up smoking reduces the incidence of heart attacks to that of someone who has never smoked, in all age groups”.
The reason why smoking imparts such a high risk of heart attacks among those who are youngest remains unclear, since studies of young smokers have confirmed that they have fewer traditional cardiovascular risk factors than older people. Of note, it is hypothesised that smoking may be “perhaps the most powerful of all risk factors, exerting its effect much sooner than any other”.
Myocardial infarction is the leading cause of death. Indians are the world leaders in incidence of diabetes, bad lifestyle and cardiovascular diseases. Owing to their inherent genetic and environmental risks, Indians, especially those who are diabetic, cannot afford to use tobacco in any form.
Dhall cited an instance where he had to counsel a patient’s wife on her role in getting her spouse who had just undergone a Primary Angioplasty after a heart attack to quit smoking.
She, while questioning societal inaction in helping people give up smoking, observed that while the country was united in fighting the menace of black money, as far as she was concerned, banning tobacco would have benefited her family more — and saved her husband from having a heart attack.
Not only had his smoking caused her young husband to have a heart attack at 33 years of age but also significantly increased her risks of having a heart attack due to passive or second-hand smoking, Dhall pointed out.
Regular exercise, balanced nutrition, care of high blood pressure, diabetes, high cholesterol, avoiding excess salt, sweets, dairy fats, red meats and refried or deep fried food while remaining stress-free may be a tall order. This needs family support, societal and peer pressure and legislative intervention if we are to reduce the prevalence of cardiovascular disease, the doctor asserted.