I. Effects of Components of Cigarette Smoke
II. Cigarette Smoke and Atheroscelerosis
III. Recent Epidemiologic Study
IV. Anginal Chest Pain and Impotence
V. Habituation and Cessation

GLOSSARY
arrhythmia general term for irregularity or rapidity of the
heartbeat. atherosclerosis a hardened plaque in the wall of an artery: the
plaque is filled with cholesterol calcium and other substances.
The plaque of atheroma hardens the artery hence the term
atherosclerosis (sclerosis equals hardening). myocardial infarction death of an area of heart muscle due to
blockage of the coronary artery by blood clot and atheroma
(atherothrombosis), medical term for a heart attack.
Epidemiologic Studies strongly support the hypothesis that cigarette smoking increases the incidence of fatal and nonfatal heart attacks. But, despite a world full of researchers, the exact constituent which resides in cigarette smoke and the pathophysiologic mechanisms responsible for cardiac events remain unknown. Ambrose et al., in an informative review, emphasize the lack of clear answers.
Low-tar cigarettes and smokeless tobacco have been shown to increase the risk of cardiovascular events in comparison to nonsmokers. Passive smoke is associated with about a 30% increase in risk of cardiac events compared with an 80% increase in active smokers. A smoke free environment in several cities reportedly has resulted in a decreased incidence of cardiac events. It is believed that if cigarette smoking were eliminated, about a quarter of a million lives now lost because of cardiovascular disease could be saved yearly in North America. Each year, lung cancer causes about 80,000 deaths. Smoking causes most cases of lung cancer, which is becoming the leading cause of death from cancer in women. Nonsmoking men age 45–55 are 10 times less likely to have a fatal or nonfatal heart attack than heavy smokers. The Multiple Risk Factor Intervention Trial showed that men at high risk who stopped smoking had a significant reduction in their mortality.

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• I. EFFECTS OF COMPONENTS OF CIGARETTE SMOKE
  Tobacco smoke contains more than 4000 components. Some of these are nicotine, carbon monoxide, ammonia, benzene, nitrobenzene, phenol, 2,4,dimethylphenol, acet-aldehyde, hydrogen cyanide, toluene and O-cresol. Most studies have been done on nicotine and various gases, in particular, carbon monoxide (CO).
• II. CIGARETTE SMOKE AND ATHEROSCLEROSIS
  A. Nitric Oxide and Vasodilatory Function
• III. RECENT EPIDEMIOLOGIC STUDY
  In the recently published INTERHEART study reported by Yusuf et al.: ‘‘risk factors were significantly ( p < 0.0001) related to acute myocardial infarction, except alcohol, which had a weaker association ( p ¼ 0.03). After multi-variate analysis, current smoking and raised ApoB/ApoA1 ratio (top vs. lowest quintile) were the two strongest risk factors, followed by history of diabetes, hypertension, and psychosocial factors. Body-mass index was related to risk of myocardial infarction, but this relation was weaker than that of abdominal obesity (waist/hip ratio).’’
• IV. ANGINAL CHEST PAIN AND IMPOTENCE
  A. Anginal Pain
• V. HABITUATION AND CESSATION
  A. Habituation
• BIBLIOGRAPHY
  Adams, M. R., Jessup, W., and Celermajer, D. S. Cigarette smoking is associated with increased human monocyte adhesion to endothelial cells: Reversibility with oral L-arginine but not vitamin C. J. Am. Coll. Cardiol., 29:491–497, 1997.