Weeding Out Tobacco’s Role in High Cholesterol
In This Chapter
� Explaining how smoking affects cholesterol levels
� Noting the connections between smoking and cholesterol
� Identifying the typical smoker
� Finding ways to break the habit
Consider this chapter, in fact, this entire book, a nonsmoking area. In fact, close your eyes and visualize little signs up all over the virtual walls
explaining what’s wrong with tolerating tobacco, how tobacco interacts with cholesterol, and showing how to quit, right now. Then think about how this will make your healthful life style even more so.
Enumerating Smoking’s Health Hazards
Puffing on a lit tobacco stick, that is, inhaling smoke from burning, dead leaves produces the following reactions in your body:
� Raises the level of carbon monoxide in your blood, which reduces the amount of life-giving oxygen
� Injures the lining of your blood vessels
� Constricts arteries that may already be narrowed by cholesterol plaque
� Heightens your risk of high blood pressure
� Reduces the amount of blood carrying oxygen to your body tissues
� Makes it more likely that your blood will clot
� Increases your risk of sudden cardiac death, a genuinely catastrophic moment when, without warning, your heart may stop beating forever
Not to mention, smoking increases your risk of these forms of cancer:
� Bladder
� Esophagus (throat)
� Lungs
� Pancreas
And, if that’s not enough to get to you thinking, how about this: Smoking also destroys your good looks by promoting facial wrinkles.
But did you notice that this list of bad stuff smoking can do to your body is incomplete? Look carefully. Something is missing. What can it be? Surely you jest. It’s smoking’s ability to upset your cholesterol — specifically your “bad” cholesterol.
Burning up the cholesterol charts
The relationship between smoking and cholesterol is straightforward. Over time, lighting up and inhaling all those deep, “flavorful” breaths will
� Increase your total cholesterol levels.
� Decrease the level of your high-density lipoproteins (HDLs), the “good” cholesterol described in detail in Chapters 2 and 3 of this book.
� Hasten the buildup of cholesterol plaque on damaged blood-vessel walls.
� Constrict your blood vessels, increasing the risk that a passing clump of cholesterol may block blood flow.
� Increase the level of triglycerides in your blood, another risk factor for heart attacks (check out Chapter 2).
� Double your risk of heart attack, regardless of your cholesterol level.
That last point deserves serious attention, so I’ve asked my editor to print it in boldface type, and doggone if she didn’t do it!
Although many studies demonstrate a relationship between smoking and heart disease, many smokers are convinced that having a low cholesterol level reduces their risk of smoking-related heart disease. They’re wrong. Low cholesterol levels don’t protect smokers from heart disease. I can say this with impunity because I’ve read the results of the Korea Medical Insurance Company Study, the first effort to pin down a relationship between smoking, cholesterol levels, and the risk of heart attack. (Check out the “East Asia’s heart disease” sidebar in this chapter.) Do I do my homework, or what?
East Asia’s heart disease
East Asia is a part of the world that’s best known for gorgeous scenery and scrumptious food. But it’s also known for having a large population of smokers and a rate of heart disease that’s now among the highest in the world. The confusing part of this equation has been that East Asians have a high risk of heart attack even though they generally have low cholesterol levels. A good guess to clear up this confusion may be that their love of smoking is an independent risk factor against which low cholesterol offers no protection. And by golly, that’s exactly what turned up in data from the 10-year, 106,745-man Korea Medical Insurance Corporation Study, named for the volunteers who were all Korean men with insurance policies from the Korea Medical Insurance Corporation.
Based on the number of men who were either hospitalized or died from heart attack or stroke during the study, the researchers found that smoking significantly increased the risk of heart attack and stroke. Even among men with very low cholesterol levels, smokers had a risk of heart attack and stroke that was 330 percent higher than that of nonsmokers.
Conclusion? As reported in the Journal of the American Medical Association, “This study demonstrates that . . . a low cholesterol level confers no protective benefit against smoking- related atherosclerotic cardiovascular disease.” Translation: Low cholesterol levels provide no protection for smokers against heart disease caused by smoking.
Getting a bad deal on secondhand smoke
As if your own smoking weren’t bad enough for your body, somebody else’s smoking can also be hazardous to your health.
Secondhand smoke, also known as environmental tobacco smoke, isn’t some- thing you buy in a secondhand store. It’s the smoke you inhale from other people’s cigarettes, pipes, or cigars and from the air that people breathe out while they’re smoking.
Like all tobacco smoke, this recycled version contains at least 250 toxic chemicals including at least 50 known carcinogens, which is why, in 2006, the Centers for Disease Control and Prevention (CDC) issued yet another warning on secondhand smoke. For the umpteenth time, the CDC repeated that expo- sure to secondhand smoke increases the risk of heart disease by 25 to 30 percent in adult nonsmokers and increases their risk of lung cancer by 20 to 30 percent.
As for the effect on kids, don’t ask. No, do ask.
Kids and secondhand smoke
If you smoke, children in the room smoke, too. No, they don’t actually light up, but they do breathe the same air you do, so if you exhale smoke into the air, they breathe it into their lungs. In fact, the American Heart Association states that 43 percent of all American kids between the ages of 2 months and 11 years are exposed to secondhand smoke at home.
While their lungs are still developing, smoke from other people’s burning tobacco may slow the normal rate of lung development in children and increase a child’s risk of
� Eye, nose, and throat irritations
� Middle ear infections
� Reduced lung functions
� Respiratory irritations (cough, phlegm, and wheezing)
� Respiratory tract infections (pneumonia and bronchitis)
� Worsened asthma (or new cases)
Clearing the air
Is the word getting out? You bet.
No-smoking-in-public-spaces laws to ban smoking in offices, hotels, restaurants, and other indoor spaces are now commonplace in the United States. And by summer 2007, American cities had passed at least 1,124 laws banning smoking outdoors in places such as amusement parks, zoos (including the National Zoo in Washington D.C.), beaches (no more burying your butts in the sand), golf courses, and — get this one — cemeteries.
Across the Atlantic, in 2004, Ireland became the first European country to ban smoking in all workplaces, including the legendary Irish pubs. Sweden and Italy soon followed suit, and then came the big one: France.
In 2007, the French banned smoking in public practically everywhere: airports, railway stations, hospitals, schools, shops, offices, and so on. Today, in Paris, where people practically invented serious, sexy smoking, many restaurants and most cafes still permit your pampered pooch to dine along with you, but may now ban les cigarettes, which is French for small cigars — cigarettes.
Sacre bleu! But no smoke-blue air.
Identifying the Smokers
Despite all the terrible things that are known about smoking, including its effects on cholesterol levels and the consequent risk of heart disease, many people continue to puff away.
You may wonder who these smokers are. Well, wonder no more: The hard- working statisticians at the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) have crunched the numbers and come up with figures to identify U.S. smokers by age, gender, ethnicity, and level of education. It’s a hard job, but somebody had to do it.
Gender and ethnicity
The percentage of American men who smoke is slightly higher than the percentage of American women who smoke, perhaps because some women still cling to the discredited idea that women are at lower risk of tobacco-related lung cancer. Silly girls.
When it comes to ethnicity, there are distinct differences among Americans. Table 9-1 shows who is more likely to light up.
Getting older, getting smarter
When you count smokers, age matters. So do educational levels. According to the CDC, more than 2,000 new smokers younger than the age of 18 light up every day for the first time. That’s the bad news.
The good news is that as Americans get older, they’re less likely to smoke. Higher levels of education also seem to reduce the likelihood that people will smoke. Maybe the message of Table 9-2 is that as Americans get older (and smarter), they really do get wiser. At least when it comes to smoking.
Mapping the smokers
Okay. You’ve made it past gender, ethnicity, age, and education. How else do researchers classify American smokers? Geography!
Poison control
Because smoking delivers relatively small amounts of nicotine to the body, cases of nico- tine poisoning are rare, if not unknown, among smokers. But eating one cigarette, three cigarette butts, one pinch of chewing tobacco, or any tobacco-replacement medication, such as that found in nicotine gums or patches, is hazardous for an infant, small child, or pet.
Nicotine poisoning is a medical emergency that requires immediate medical assistance! Check with your local poison control center before administering any therapy. The possibility of your tobacco use harming another person in this way is just one more reason to seriously consider the information contained in the “Breaking the Habit” section in this chapter.
Where you live in the United States says a lot about whether you’re likely to be a smoker. According to the CDC:
� In 2005, the percentage of adults who smoke ranged from a high of 28.7 percent in Kentucky and 27.3 percent in Indiana all the way down to a low of 11.5 percent in Utah.
� For men, the states with the highest percentages of smokers were Kentucky (30.6 percent), Indiana (29.7 percent), and Alabama (28.5 percent). Lowest? Utah, again, at 13.7 percent.
� More women smoke in Kentucky (26.9 percent), West Virginia (26 per- cent), and Indiana (25.1 percent). Fewer light up in good old Utah (9.3 percent).
What makes the difference? Must be something in the air.
For those of you who prefer pictures, Figure 9-1 shows the CDC smoking map of the United States in 2005 with the states ranked according to the percentage of adults who are smokers (defined here as people who smoke every day).
Breaking the Habit
A smoker’s risk of coronary artery disease (CAD) rises in direct relationship to the number of cigarettes he or she smokes each day:
� Smokers who quit have only half the CAD risk of people who keep smoking.
� People who quit after having coronary artery bypass surgery or a heart attack, fairly good signals that it’s time to quit, lower their risk of early death.
� Quitting decreases the likelihood of illness and the risk of death for people with atherosclerosis (cholesterol buildup) in arteries other than those that supply the heart and brain.
Ending your relationship with tobacco isn’t a Sunday walk in the park. Nicotine is such a rewarding drug that leaving it behind takes time and effort — a lot of time and effort in many cases. People often feel guilty when their first attempt at breaking the habit isn’t totally successful. That’s nonsense!
Not quitting forever the first time you try to stop smoking is neither a crime nor a moral failure. In fact, not making it the first ten or twenty times isn’t the end of the world. Every time you stop smoking, you keep your body free of tobacco smoke for hours, days, or weeks. Consider that an accomplishment to celebrate. In the end, the only important thing is the end of smoking. Eventually, you’ll get there.
But from the moment you stop (for as long as you stop), your body benefits. Table 9-3 shows exactly how.
Choosing How to Quit
When you decide to quit — right now would be a really good time — you have four basic ways to go:
� You can just quit.
� You can quit with the help of medication.
� You can quit with the help of a behavior-modification program.
� You can try one method from column A, one from column B, and one from column C — in other words, you can take the smorgasbord approach.
The good points and bad points of each of these methods are described in the following sections.
Quitting cold turkey
I decided to stop smoking when my habit reached three packs a day and everything — my apartment, my clothes, my hair — smelled like dead cigarettes.
As a highly competitive, Type A person, I couldn’t stand the thought of being beaten by a paper tube filled with crumbled leaves. Naturally, when I decided to quit, I took the cold-turkey route. The first six weeks weren’t pleasant. I really, really wanted a cigarette, and it was really, really hard not to give in to my craving. Worse yet, I was so used to lighting up when I typed that I couldn’t write a coherent sentence for weeks. Luckily, my editors understood and supported my desire to quit. To make the situation bearable, I made some concessions to reality. You may also find them useful.
Concession #1: Stop smoking, but don’t throw out the cigarettes
An about-to-be-ex-smoker’s worst nightmare is waking up at 4 a.m. without a cig in the house. At that point, resolve dissolves during a frantic search through every possible drawer and coat pocket in the house. Without the comforting thought that a cigarette is close at hand, should it be necessary, the willpower-challenged sort of ex-smoker may succumb to panic and rush to the corner gas station to buy — you guessed it — cigarettes!
To keep my own panic in check, I kept a pack of cigarettes in my purse for about two years, and I kept a pack in the back of my desk drawer for what turned out to be seven years. When I found the withered cigarettes by accident, seven years after I had stopped smoking, I was able toss them in the trash without a second’s hesitation.
Concession #2: Don’t promise more than you can deliver
When coworkers stopped at my office door to say, “Hey, I hear you’ve stopped smoking,” I would grin like a Cheshire cat and purr, “Well, at least for this morning,” or “this afternoon,” or whatever.
A lot of people consider this weak-willed. I call it telling the truth. I knew, for example, that I could make it through an hour, and then four hours, and then a morning, and then an afternoon, and then a day. But I really didn’t know what would happen after these increasingly longer periods of smoke-free time. By not saying “Never!” to the possibility of smoking again, I avoided setting myself up for a fall.
Concession #3: Don’t be a nag
Ex-smokers can be very annoying. It’s not their business if someone else wants to muck up his lungs or stink up her clothes. After you decide to stop smoking, let other people come to the same conclusion on their own. And don’t give up your smoking friends. The funny thing is that smokers may smell bad, but they’re often looser and more fun than nonsmokers.
Concession #4: Don’t sweat the small, guilty pleasures
Once in a while, when we’re out walking, my husband and I get a whiff of a pipe or a cigar. Our eyes sparkle. Our step quickens. And we follow that smoker for a couple of blocks, remembering. But we’ve never lit up — so far (see Concession #2).
Letting loose
After I stopped smoking, it was only a matter of time until my husband gave into my nagging. (I didn’t mean you shouldn’t nag your loved ones; just leave strangers alone.) Several years later, we received an assignment to write about a weekend at a honeymoon hotel. In the dining room, the seating plan was tables for eight. On the first night, the only open seats were at a smoking table. We agreed to sit there, and we had such a great time that we kept going back to sit with the smokers. (No, we didn’t smoke.)
The last morning, there were no open seats at our regular table, so we sat with the ex-smokers. What pills! They kept grabbing the butter and wouldn’t let us have it. Frankly, a discreet smoker’s cough would’ve been more welcome.
Applying effective medicines
For some people, the path to a smoke-free nirvana runs through a prescription, either for the antidepressant medication bupropion (formerly known as Wellbutrin; now known as Zyban) or the new nicotine-blocker varenicline (Chantix).
Anti-smoking medicine #1: Buproprion
In several well-controlled studies, buproprion (Zyban) alone, with no counsel- ing or other therapy, helped nearly 50 percent of the people who took it stay smoke free for seven weeks and aided roughly 23 percent of people in avoiding cigarettes for at least a year. These figures may not sound all that impressive, until you hear that only 4 to 7 percent of smokers who try to quit on their own are able to make it for a full year without cigarettes. As a result, in 1997, the Food and Drug Administration (FDA) approved buproprion as a stop-smoking aid.
Buproprion does have some potential adverse effects: upset stomach, head- ache, insomnia, irritability, and seizures in people with a history of seizure disorders. But the medicine also has an interesting benefit in addition to its ability to diminish cravings for a smoke. Smokers who kick the habit often gain weight in the process, but buproprion actually produces a slight weight loss. No smoking, no weight gain, and it’s covered by insurance? Glory, glory!
Anti-smoking medicine #2: Varenicline
When you smoke, the nicotine in your tobacco hooks onto receptors in your brain that tell the brain to release dopamine, a natural mood elevator. The newest anti-smoking med, varenicline (Chantix), approved by the FDA in the spring of 2006, is a chemical that clicks into place on these brain receptors, blocking nicotine so that smoking fails to produce its usual “high.” In double- blind studies (studies in which neither the researchers nor the subjects know what they are getting), varenicline enabled 44 percent of people who had been smokers for as long as 24 years to quit smoking after 12 weeks.
The most common side effects of varenicline are gastric upset (nausea, vomiting, intestinal gas, and constipation) and sleep disturbance (frequent waking and vivid dreams). The drug has not been approved for women who are pregnant, plan to be pregnant, or are nursing. In addition, this medicine may interact with anticoagulants (“blood thinners”), asthma medication, and insulin.
Get your nicotine here!
Smoking is both a chemical addiction and a psychological habit. By stopping smoking, you immediately break the psychological habit of putting a cigarette in your mouth. Nicotine replacement therapy (NRT) products help deal with the chemical addiction by delivering small doses of nicotine to your blood- stream to make up for what you give up when you quit cigarettes. They also help reduce your cig cravings by lessening common withdrawal symptoms such as irritability, headache, sleep disturbances, and fatigue.
Most cigarettes sold in the United States contain 10 milligrams (mg) of nico- tine each, delivering about 1 to 2 mg of nicotine per smoked cigarette — yes, you lose some nicotine because the cigarette burns down between puffs. The best way to use all nicotine replacements is to start at a dose equivalent to the number of cigarettes you smoke a day, and over each subsequent month, reduce the amount you use daily by either going to a lower concentration or fewer ingestions of nicotine. NRTs are often most successful when taken along with buproprion.
To get the best results from a NRT, start using your preferred method as soon as you quit smoking. You shouldn’t use any NRT for longer than three months. Some people find these products incredibly effective when used on their own; others may need the extra help that can come from counseling or participating in a smoking-cessation program with other people. And always check with your doctor before starting to use these products. Like all medicines, they (the NRTs) do have potential side effects and interactions.
Nicotine chewing gums
You don’t need a prescription to buy nicotine-replacement chewing gum, but you do need to be 18 or older. The manufacturers’ directions usually tell you to start with one tablet per hour. If you smoked fewer than 24 cigarettes a day, the 2-mg gum should be fine; people who smoked more may need the
4- mg dose. To get the most bang from your gum, avoid food and beverages for 15 minutes before chewing. (Some foods and beverages reduce the gum’s effect.)
If necessary, you can take an additional piece to tamp down a sudden craving, but you shouldn’t use more than 30 pieces of gum a day. And do remember to follow the directions when chewing the gum. You stick the wad between your lip and gum so that the nicotine makes its way into your system. If you forget to do that, the gum may make you queasy.
Transdermal patches
The nicotine patch is a medical device that delivers a constant amount of nicotine through your skin. Nicotine patches come in two versions: a 16-hour patch that you wear while you’re awake and a 24-hour patch for people who wake up craving a cigarette. The patch, which started life as a prescription drug, is now available over the counter.
But it’s always a good idea to check with your doctor before using it because, as the American Lung Association notes, potential side effects may include
� Headache, dizziness, and blurred vision
� Itchy or burning skin
� Sleep disturbance (vivid dreams)
� Upset stomach and diarrhea
When you remove your nicotine patch, dispose of it carefully and as directed. (The package comes with storage space for used patches.) Remember: Nicotine is a poison. The amount of nicotine in your discarded patches may be lethal for pets and small children.
The nicotine inhaler is a plastic cylinder that looks like a cigarette, but instead of tobacco, it contains a pressurized cartridge filled with nicotine mist. When you puff on the inhaler, the nicotine mist is absorbed through the mucous membrane lining your mouth and throat.
The inhaler is a prescription product, with a maximum dose of six cartridges a day. Ask your doctor about the inhaler’s risks and benefits, and be absolutely sure to read the instructions carefully before using this device.
Nasal sprays
You can take two spritzes from this pump bottle, one in each nostril, up to five times an hour. The spray delivers nicotine straight to the mucous mem- brane lining your nose, which lets the nicotine zip into your bloodstream faster than it does with gums, patches, or inhalers.
Like the inhaler, the spray is a prescription product. And, as with all nicotine- replacement therapies, you should read the patient insert to check out the possible side effects and drug interactions.
Comparing the alternatives
Table 9-4 briefly reviews the different types of nicotine-replacement products. All are available as generics and as brand-name meds. As with most drugs, you can count on the generics being equally effective at a lower price.
Modifying your behavior
When you decide to quit smoking, behavior modification programs can be a valuable tool in teaching you how to avoid or ignore the emotional and physi- cal triggers, such as anxiety or nicotine cravings, that tell you to light up.
Here are some suggestions:
� You can get your behavior-modification advice from a stop-smoking clinic or a stop-smoking book. As with every other step associated with quitting smoking, the best solution is the one that works for you.
For information about behavior-modification programs to help you quit smoking — and even good books on how to toss the tobacco — visit the American Lung Association (ALA) Web site at www.lungusa.org. The ALA has a ton of information to help you declare freedom from smoking.
� Don’t want to go through ALA? No problem. You can also call your local hospital, YMCA, or YWCA. At least one of these organizations is almost guaranteed to have a low-cost or maybe even free smoking-cessation program.
Hypnosis and acupuncture
Think of hypnosis and acupuncture therapies as effortless behavior modification. Someone else does the work — waving a magic hypnosis wand or sticking skinny needles in various parts of your body — and you reap the benefits.
Many hospitals have trained professional hypnotists and acupuncturists on staff, so one path to a reliable practitioner is through your doctor or local hospital.
Although no evidence shows that either hypnosis or acupuncture is any more effective at ending your smoking habit than the other stop-smoking therapies, both approaches do turn some smokers into ex-smokers. If you’re one of those people, hooray! If not, just pack up your bags and move on to another method. Just remember — no quitting on your quitting. Okay?
Future perfect
Today’s stop-smoking techniques aren’t perfect, so smarties around the world are always on the lookout for better ways to break the habit. This section covers two interesting works-in-progress.
Eating your way out of the cigarette pack
Believe it or not, in 2007, scientists at Duke University’s Nicotine Research Program in Durham, North Carolina, the very heart of tobacco-growing coun- try, reported that drinking milk and water or eating fruits and veggies seems to make tobacco taste yucky, while alcohol beverages, coffee, and meat have just the opposite effect.
Is this the way to a stop-smoking diet? Couldn’t hurt, according to program director Jed E. Rose, who recommends diet modification along with any standard stop-smoking stratagem you prefer.
Anticipating the quit-smoking vaccine
Wouldn’t it be nifty if you could just zip off to the doctor for an anti-smoking shot? Take heart: Dr. Dorothy Hatsukami and her colleagues at the University of Minnesota Medical School are working on it.
Their solution, reported in the November 2005 issue of the medical journal Clinical Pharmacology and Therapeutics, is a vaccine that enables your body to produce nicotine antibodies — teensy molecules that hook on to nicotine molecules to prevent them from making their way into your brain.
Volunteers given the experimental vaccine four times in one 26-week period were more likely to be able to stay away from cigarettes for 30 days without nasty withdrawal symptoms than those given a placebo (look-alike) injection. Both those who received the vaccine and those who received the placebo reported a similar incidence of mild or moderate side effects (headache, cough, or upper respiratory tract infection).
Hatsukami’s research is a work in progress. Keep your eyes peeled for more info.
Movie babes and butts
Many smokers lit up their first cigarettes because some movie star looked so darned cool smoking. Unfortunately, some of the great- est stars, such as John Wayne and Bogie, went to their untimely reward courtesy of that cool cig. Nonetheless, smoking is still a prominent silver-screen fixture. In Basic Instinct, Sharon Stone uttered this really great line: “What are they going to do, arrest me for smoking?” These days, in a lot of American cities, the answer is, “We could if we wanted to.”
Take the following quiz and match the star with the movie in which she lit up. And by the way, if you still think that smoking is sexy, imagine the poor hero who had to kiss the glamorous woman with the awful tobacco breath.
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