Smoking

Loading...

From the course by University of Zurich

Myocardial Infarction

55 ratings

Explore Related Videos

At Coursera, you will find the best lectures in the world. Here are some of our personalized recommendations for you

University of Zurich

Myocardial Infarction

55 ratings

Cardiovascular diseases are – according to the (World Health Organization (WHO) – the number one cause of death globally. Myocardial infarction (heart attack) is the most prominent under the Cardiovascular diseases. In Switzerland alone, the risk to develop a coronary heart disease during life time is around 25% for men and 18% for women. Most cardiovascular diseases can be prevented by addressing behavioral risk factors, the understanding of these risk factors, their mechanisms and impact on the cardiovascular system. In this context our course aims to approach the complex field of myocardial infarction in two respects: medical education and awareness of a broader audience.

From the lesson

Risk Factors and Prevention of Cardiovascular Diseases

Whereas the first module focuses on different physiological aspects of the heart and the cardiovascular system, the second module considers several external risk factors which can cause a myocardial infarction. This module not only discusses the risks such as aging, smoking, hypertension, lipids and diabetes, but also explains which preventive measures can be employed to minimize the risk of a heart attack, for example, by focusing on physical exercise to increase life expectancy and the personal health.

Meet the Instructors

Prof. Thomas F. Lüscher
MD, FRCP, FESC, FACC
Professor and Director of the Cardiology Department, University Heart Center Zurich, University Hospital Zurich

Hello everybody, my name is Isabella Sudano,

I'm a general consultant in the cardiology unit of the University Hospital of Zurich,

and the topic of today is smoking tobacco and cardiovascular disease.

Tobacco is a wonderful plant with a self-defense secret and

the secret is nicotine.

Nicotine acts as a natural pesticide and kills the insects who try to eat the leaves.

What is lethal for these insects is really interesting for our brain.

When we use nicotine, it has an effect

on our pleasure center by activating the reward center, which is

one of the oldest parts of our brain, leading to the release of dopamine,

and other mediators that are responsible for the effect of nicotine.

When I'm sleepy, I can get awake with nicotine.

When I need more attention or creativity, there is also a positive effect of nicotine.

At least at the beginning, nicotine has positive effects on our brain.

That's the reason why our brain likes nicotine and why nicotine is so addictive.

In Europe we have a prevalence of male smokers around 40%,

female prevalence around 20%.

There are some differences:

There are countries, like Asia, for example, where the prevalence

of female smoking is much more reduced as compared to the European mean.

In Switzerland, we have around 22% of women who

are smokers, and around 30% of the male.

And that's really a pity because a woman who is a smoker lives as

a mean 11 years less than a woman same age who is a nonsmoker.

For the men the difference is 12 years.

Why does tobacco let us lose so many years?

At first, we can say that all cancer, not only lung cancer,

are more often diagnosed in smokers compared to nonsmokers.

All cardiovascular disease such as stroke, myocardial infarction, but

also rectal dysfunction and

vascular dementia are more often in smokers as compared to nonsmokers.

Chronic lung disease, diabetes, the eye is also involved, age-related macular

degeneration is much more often in people using tobacco as compared to nonsmokers.

As well as rheumatoid, arthritis and other diseases that

are due to changes in our immune system and reduced fertility.

Looking at Switzerland, a man living in Switzerland has a 3

times higher risk of dying as compared to a nonsmoker.

A woman has a 3.5 higher risk factor of coronary artery disease

and the men have a 15% higher

risk factor of lung cancer when he's a smoker.

That means that around 9,000 people are dying every

year in Switzerland because of tobacco use.

Let's see in detail why tobacco and smoking is so dangerous for us:

In every cigarette, in every tobacco product,

we have oxidant chemicals that lead to inflammation, platelet activation and

endothelial dysfunction, leading to reduced myocardial perfusion,

reduced oxygen availability and coronary occlusion.

Altogether, it leads to myocardial ischemia, infarct, and a higher risk of sudden death.

One big player is carbon monoxide that we take in when we

smoke tobacco, which reduces oxygen availability and

worsens the coronary vasoconstriction.

Nicotine may activate the sympathetic nervous system and increase the heart rate,

blood pressure, and myocardial contractility.

Altogether, they increase the risk of myocardial ischemia, infarction and

sudden death.

There is no product, no tobacco product, which does not lead

to an increase in myocardial infarction and other cardiovascular disease.

Doesn't matter if I use cigarettes with or without filter, cigars,

pipe, chewing tobacco, the combination of chewing and smoking tobacco.

Water pipe, if I use water pipe regularly,

then I also have an increase in coronary artery disease and

second hand smoking is also dangerous.

As we can see here, the endothelial dysfunction is exactly the same

if I'm an active smoker, or a passive smokers, as compared to nonsmokers.

There are many tobacco products, light cigarette, snus, electronic cigarette,

or the new hit of not-burn tobacco that are proposed to be lower risk products.

But in reality, there is no tobacco product that could be defined as safe.

You can reduce the risk of lung disease, but

we will increase anyway the risk of general cardiovascular disease or cancer.

If we stop smoking, stop using tobacco, then we have many benefits.

Taste and smell are back again within one week.

The carbon monoxide will disappear after 8 hours and

with the time the risk of cardiovascular disease or a cancer will decrease.

How can we help people on the way to smoking cessation?

At first, we identify people who are using tobacco.

Tell them that the best thing for

their health will be to stop smoking or using tobacco.

Then look how much they are addicted, if they're motivated to stop or

not and find a system, find with them a strategy.

And after the smoking cessation, they don't feel alone,

we have to follow up on them.

Look at smoking cessation and cardiovascular risks:

A never smokers, is assessed as reference.

A former smoker will stop after 8 years of smoking

and has a lower risk of heart failure.

If I was smoking for more than 30 years, then my risk

will be reduced but will not go back to the never smoker level.

If I'm a current smoker, then I have the highest risk.

We can use drug to help people in the process of smoking cessation and

if we use nicotine replacement therapy we can reduce the possibility of death or

myocardial infarction.

If we use bupropion or varenicline then we don't have an increase

in cardiovascular disease morbidity or mortality.

So, in conclusion all tobacco products

are associated with an increased risk of atherothrombotic disease.

Cessation of smoking or

tobacco product use is also said to reduce cardiovascular risk.

It's important to stop as soon as possible because the time of exposition to

tobacco and the dose, so, how many cigarettes I smoke,

for example, are important factors determining cardiovascular risk.

Smoking cessation is very cost effective.

Drug used for smoking cessation such as nicotine replacement therapy, bupropion or

varenicline are not associated with an increase in cardiovascular risk.

Thank you so much for your attention.

Explore our Catalog

Join for free and get personalized recommendations, updates and offers.

Coursera provides universal access to the world’s best education, partnering with top universities and organizations to offer courses online.

© 2019 Coursera Inc. All rights reserved.

Download on the App Store

Get it on Google Play