Figure 1
Pathogenesis of endothelial dysfunction.
EC, endothelial cells; VSMC, vascular smooth muscle cells; ICAM-1, intercellular adhesion molecule-1; VCAM-1, vascular cell adhesion molecule-1; NO, nitric oxide; ET-1, endothelin 1. Created using Biorender.com.
Figure 2
Inflammation at the cellular level induced by smoking.
TLR, Toll-like receptor; cGAS, cyclic GMP–AMP synthase; STING, stimulator of interferon genes; mtDNA, mitochondrial DNA; IL, interleukin; ROS, reactive oxygen species; GSDMD, Gasdermin D-mediated pyroptosis. Created using Biorender.com.
Table 1
Health study data overview by region (40).
| REGION | NUMBER OF PARTICIPANTS | NUMBER OF STUDY COHORTS | RANGE OF SURVEY YEARS | BASELINE AGE (INTERQUARTILE RANGE, YEARS) | PERCENTAGE OF MALES | SMOKING PREVALENCE (%) |
|---|---|---|---|---|---|---|
| Global | 1,518,028 | 112 | 1963–2020 | 54.4 (45.2 to 63.0) | 45.9 | 21.6 |
| North America | 65,182 | 11 | 1971–2011 | 54.0 (45.0 to 63.0) | 45.9 | 22.5 |
| Latin America | 191,244 | 10 | 1990–2013 | 54.0 (45.0 to 63.0) | 45.9 | 30.8 |
| Western Europe | 907,760 | 58 | 1970–2015 | 54.6 (45.5 to 63.0) | 45.9 | 20.9 |
| Eastern Europe and Russia | 51,133 | 16 | 1983–2014 | 54.1 (45.5 to 63.0) | 45.9 | 29.2 |
| North Africa & Middle East | 185,608 | 5 | 1963–2020 | 54.0 (45.0 to 62.6) | 45.9 | 14.2 |
| Sub-Saharan Africa | 10,390 | 2 | 2011–2017 | 54.0 (45.0 to 63.0) | 45.9 | 18.6 |
| Asia | 59,802 | 4 | 1988–2015 | 54.0 (45.0 to 63.0) | 45.9 | 23.5 |
| Australia | 46,909 | 6 | 1983–2007 | 54.6 (45.5 to 63.0) | 45.9 | 14.3 |
Table 2
Population-attributable fraction (PAF) of smoking to cardiovascular diseases (CVD) according to different regions (40).
| GEOGRAPHIC REGION | WOMEN (PAF) | MEN (PAF) |
|---|---|---|
| % 10 YEARS OF CVD | % 10 YEARS OF CVD | |
| Global | 6.7 | 10.7 |
| North America | 7.0 | 7.9 |
| Latin America | 6.6 | 9.6 |
| Western Europe | 8.7 | 8.6 |
| Eastern Europe and Russia | 3.0 | 16.3 |
| North Africa and Middle East | 4.8 | I3.3 |
| Asia | 5.4 | 20.2 |
| Australia | 5.7 | 5.7 |
Figure 3
Structure and evolution of electronic cigarettes. E- electronic cigarette (59). Created using Biorender.com.
Table 3
Comparison of cardiovascular adverse effects in active, passive, and electronic smoking.
| ACTIVE SMOKING | PASSIVE SMOKING | VAPING | |
|---|---|---|---|
| Heart disease | Significant risk due to plaque buildup and oxidative stress | Increased risk especially with prolonged exposure | Possible increased risk, but lower than smoking |
| Stroke | Significant risk due to hypercoaguable state | Increased risk | Limited evidence |
| Hypertension | Nicotine-induced vasoconstriction | Possible mild increase due to nicotine exposure | Temporary elevation in BP with nicotine-containing e-liquids |
| Heart Rate | Increase in resting pulse due to nicotine stimulation | Possible temporary increase. | Increase in heart rate after vaping with nicotine |
| Atherosclerosis | Accelerated plaque formation | Risk of contributing to plaque formation | Limited data; less risk than smoking |
| Oxidative Stress | Increased oxidative stress contributing to atherosclerosis | Increased oxidative stress from secondhand smoke | Reduced oxidative stress compared to smoking but not eliminated |
| Cholesterol | Increased LDL and decreased HDL | Indirect effects possible with long-term exposure | potential mild effect on lipid profiles |
Figure 4
Stages of change in patients undergoing smoking cessation management. Created using biorender.com.
Figure 5
Five A’s algorithm (ask, advise, assess, arrange, assist) in smoking cessation counselling. Created using biorender.com.
Figure 6
Five R’s algorithm (relevance, risk, rewards, repetition, roadblocks) in motivational interviewing of smoking cessation. Created using biorender.com.
Table 4
First line pharmacologic agents for smoking cessation.
| GENERIC NAME | DOSE | ADVERSE EFFECTS |
|---|---|---|
| Nicotine Gum | 2 mg gum for <25 cig./day 4 mg gum for >25 cig./day Use up to 12 weeks, no more than 24/day | Jaw pain, mouth soreness, dyspepsia, hiccups |
| Nicotine Lozenge | 2 mg lozenge for 1st cig >30 min 4 mg lozenge 1st cig <30 min of waking Use up-to 12 weeks, no more than 20/day | Mouth and throat hiccups |
| Nicotine Patch | >10 cig/day, 21 mg patch for 6–8 weeks <10 cig/day, 14 mg for 6 weeks, 7 mg for 2–4 weeks | Mild skin irritation at placement site |
| Nicotine Inhaler | A dose form consists 1 inhalation. Recommended dosage is 6–16 cartridges/day, up to 6 months | Mouth and throat irritation and cough |
| Nicotine Spray | Spray 1–2 dose/hour Minimum 8 dose/day, maximum 40 dose/day Recommended for 3–6 months | Runny nose, nasal and throat irritation, cough |
| Bupropion SR | Begin 1–2 weeks before quit date. Start at 150 mg for 3 days, then 150 mg twice a day, up to 6 months post-quit | Insomnia, dry mouth, headaches, tremors, nausea, anxiety |
| Varenicline | Start 1 week before quit date at 0.5 mg once daily for 3 days, then 0.5 mg twice daily for 4 days, then 1 mg twice daily for 3–6 months | Nausea, headaches, insomnia, abnormal dreams |
Figure 7
Guidelines for smoking cessation according to the European Network for Smoking and Tobacco Prevention (ENSP) (102), bupropion SR, NRT. Created using Biorender.com.
Figure 8
Guidelines for smoking cessation according to the Journal of American College of Cardiology (JACC) (110) bupropion SR, NRT. Created using Biorender.com.