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Epidemiology of CVD and

Mini Lecture 1
Module: Tobacco effects on cardiovascular

Objectives of the Mini Lecture

GOAL OF MINI LECTURE: Provide students with
knowledge on the burden of smoking and tobacco use
among patients with cardiovascular diseases (CVD)
Learners will be able to:
List the global burden of CVD and smoking
Discuss the burden of smoking in CVD patients
Describe the association between active and passive
smoking and CVD


Epidemiology of CVD and Tobacco

Mini Lecture 1
Module: Tobacco effects on cardiovascular system

Cardiovascular diseases (CVD) as

leading cause of global death
Globally, non-communicable diseases (NCD) accounted for
58% and 62% of deaths in men and women, respectively, in
Cardiovascular diseases (CVD) death in 2004: 26.8 million
in men and 31.5 million in women
Two leading causes of death: ischemic heart disease
(12.2% of all deaths) and cerebrovascular disease (9.7%)
Both diseases were the leading causes of death globally,
in middle- and high- income countries.
In low income countries, ischemic heart disease came 2nd
(9.4%) and cerebrovascular disease came 5th (5.6%).
World Health Organization., 2008.

Global tobacco-attributable deaths

In 2030, smoking will account for 10% of global death
Between 2002-2030, tobacco-related deaths are
projected to:
Decrease by 9% in high-income countries
Double in low-and middle-income countries (from 3.4
million to 6.8 million)
Leading causes of tobacco-attributable deaths are:
cancer (33%), cardiovascular diseases (29%), and
chronic respiratory diseases (29%).

Smoking-attributable death in Asia

Smoking attributable to 30% of cardiovascular death in
Pacific and South-East Asia regions. (Martiniuk et al., 2006)
Smoking causes
10-33% of heart diseases among men (10% in
Australia and 33% in Kiribati)
3-12% of hemorrhagic stroke among men (3% in
Australia and Palau, and 12% in Kiribati)
8-27% of ischemic stroke among men (8% in Australia
and 27% in Kiribati)

Prevalence CVD in Indonesia

Indonesians national prevalence for :
- Heart diseases:
7,2 % based on symptoms told by patients
0,9 % based on health practitioners diagnose
- Hypertension diseases:
31,7% based on measurement
7,2% based on health practitioners diagnose
(Basic Health Survey, 2007)

So far, national data on smoking attributable death in

Indonesia is not available. Further research on this is
urgently needed.

Smoking as CVD risk factor

Smoking is an established risk factor for many
cardiovascular diseases such as: peripheral vascular
disease (PVD), aortic aneurysm, coronary heart disease
(CHD), and cerebrovascular disease (stroke)
12 % of death in China were attributable to smoking
(22% were respiratory disease, 16% neoplastic disease,
and 9% vascular disease)
Smoking attributable to 30 % of cardiovascular death in
Pacific and Southeast Asia region.

World Health Organization, 2002; Niu SR, et al. BMJ 1998;317(7170):1423-4.

Cost-effectiveness of Smoking
Cessation for CVD Prevention

Compared to different CVD prevention strategies (ex.

Lowering blood pressure, blood glucose, LDL cholesterol,
BMI), smoking cessation is the most cost-effective
intervention for CVD prevention.

Kahn et al. (2008)

Cardiovascular risks of
secondhand smoke
Secondhand smoke (SHS) increases the risk of coronary
heart disease among nonsmokers by 25%-30%, for both
among men and women, and exposure in home and
A significant dose-response relationship between intensity
and duration of exposure to SHS and CVD risks
Risk increases sharply with low doses of SHS (< 5
Risk increases more slowly and linearly with higher level
of exposure (5-20 cigs/day)
(He et al., 1999; Pechacek et al., 2004)


Epidemiology of CVD and Tobacco

Mini Lecture 1
Module: Tobacco effects on cardiovascular system

Constituents of Cigarette Smoke

That Contribute to CVD
Main contributors :
Carbon monoxide
Oxidant (chemical) gases: oxides of nitrogen and freeradicals
Other contributors promotes atherogenesis:
Polycyclic aromatic hydrocarbons
Other constituents

Benowitz NL. Prog Cardiovasc Dis 2003; 46(1) : 91-111

Tobacco use and Acute Myocardial

Infarction (AMI)
A current smoker has three times risk to experience nonfatal MI compared with never smoker
Dose response relationship between number of
cigarettes smoked per day and risk of AMI independent
with age
The risk of AMI increase even with low levels of smoking
Risk increases by 5.6% for every additional cigarette

Teo et al (2006)

Factors associated with risk of AMI

Young smokers are at higher risk of AMI compared to
older smokers
higher prevalence of smoking
higher numbers of cigarettes smoked per day
Risk of acute myocardial infarction (AMI) from:
smoking beedies: 2.89
chewing tobacco: 2.23
smoking and chewing: 4.09
low doses of exposure (1-7 hour/week)=1.24
high doses of exposure (>21 hour/week)=1.62
Teo et al (2006)