Overview

DatafromtheNationalPopulationHealthSurveyandtheCanadianCommunityHealthSurveysuggeststhattheprevalenceof
heartdiseaseandtheriskfactorsofhypertension,diabetesandobesityincreasedfrom1994to2005inallagegroupsin
Canada.1Cigaretteconsumptiondeclinedduringthisperiod,butsmokingratesremainedhigh(about3.2millionmenand2.7
millionwomenstillweresmokinginCanada).1

TheLinkbetweenSmokingandCardiovascularDiseaseandDiabetes
Smokingisanimportantriskfactorforhypertensionanddiabetes,andisariskfactorfordeath,chieflyfromcardiovascular
disease.24
Smokinginfluencesatherosclerosisateverystage,rightfromthestageofendothelialdysfunctiontotheoccurrenceofan
acuteclinicalevent.5Smokingisassociatedwithelevatedlevelsofcardiovascularriskfactorsincludingfibrinogen,C
reactiveproteinandhomocysteine.Keymechanismsbywhichsmokingcontributestoatherosclerosismayinclude
Inflammationandhyperhomocysteinemia.Peoplewhocurrentlysmokehavehigherlevelsoftheseriskfactorsthanthose
whoformerlysmoked.Riskfactorlevelsincreasedwiththenumberofcigarettessmoked.6
Smokingincreasesconcentrationsofplasmatriglycerides,decreaseshighdensitylipoproteincholesterolconcentrations,
andimpairsglucosetolerance.79

Impact
Therewereanestimated37,209tobaccoattributeddeathsinCanadain2002,amountingto16.6%ofalldeathsinthat
year.Ofthese,10,853deathswereattributabletocardiovasculardisease.Deathsduetotobaccousewereassociatedwith
alossof515,607potentialyearsoflife,andillnessesattributedtotobaccousewereresponsiblefor2,210,155daysofacute
careinhospital.10Ifcurrentratesoftobaccousecontinue,approximately1millionCanadianswilldieoverthenext20
yearsasadirectresultofsmokingandsecondhandsmoke.11
Comparedtowhiterespondents,membersofvisibleminoritiesinCanadahadalowerprevalenceofdiabetes(4.5%v.
4.0%),hypertension(14.7%v.10.8%),andsmoking(20.4%v.9.7%).12HighratesofsmokingamongAboriginalpopulations
areassociatedwithanincreasingprevalenceofcardiovasculardisease.13
TheNursesHealthStudyshowedthat14womenwithtype2diabetes,whonolongersmokedhadarelativeriskfor
coronaryheartdiseaseof1.21comparedwiththosewhoneversmoked;therelativeriskwas1.66forwomencurrently
smoking114cigarettes/day,andtherelativeriskwas2.68forwomencurrentlysmoking15cigarettes/day.Theriskfor
diabeticwomenwhostoppedsmokingformorethan10yearswassimilartothatforwomenwithdiabeteswhonever
smoked.
Ametaanalysis15of32studiesandshowedthattheoverallriskofstrokeassociatedwithsmokingis1.5.

Actions
Healthcareproviderscanpositivelyimpacttheirpatients'abilitytoquitsmoking,yetfewintegratecessationcounselling
intoroutinepractice.Smokingcessationtrainingforhealthcareproviderscanresultinsignificantandlastingimprovement
incounselling,andanincreaseinassistingpatientstoquit.16
Simplesmokingcessationadvicefromaphysicianalonecanresultin3%ofpatientsquittingwithoutrelapsewithin1year.17

Actions(contd)
Participationinasmokingcessationprogrammecanproducedifferences(comparedtousualcare)ofupto35%,withan
averageofalmost20%morepatientsquitting.18
TheCANADAPTTGuidelineDevelopmentGrouprecommends19thathealthcareprovidersshould:
Askpatientsabouttobaccousestatusonaregularbasis.
Clearlyadvisepatients/clientstoquit.
Assessthewillingnessofpatientsorclientstobegintreatmenttoquitsmoking.
Offerassistancetoeverytobaccouserwhoexpressesthewillingnesstobegintreatmenttoquit.
Conductregularfollowuptoassessresponse,providesupportandmodifytreatmentasnecessary.
Referpatientsorclientstorelevantresourcesaspartofthetreatment,whereappropriate.

HelpfulResources
HealthCanada.SmokingandHeartDisease.<http://www.hcsc.gc.ca/hcps/tobactabac/bodycorps/diseasemaladie/heartcoeur
eng.php>
PublicHealthAgencyofCanada.HeartDiseaseandStrokeinCanada1997:RiskFactorsforCardiovascularDisease.
<http://www.phacaspc.gc.ca/publicat/hdsc97/s06eng.php>

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