Can Smoking Cause Angina?

Overview

According to the 2014 Surgeon General's Report on smoking and health, smoking is a leading cause of the cardiovascular disease (CVD).1 It is responsible for one out of every four fatalities from CVD. CVD accounts for a quarter of all fatalities in the United Kingdom, or more than 160,000 deaths annually; an average of 460 deaths per day or one death every three minutes.2 There are around 7.6 million heart or circulatory disease sufferers in the United Kingdom, including 4 million males and 3.6 million women.2 Each year, heart attacks account for up to 100,000 hospital admissions in the United Kingdom every five minutes. Approximately 1,400,000 individuals in the United Kingdom have survived a heart attack.

Even those who smoke less than five cigarettes per day may exhibit early indications of CVD.1 The risk of cardiovascular disease rises with the number of cigarettes smoked each day and the duration of smoking. Cigarettes with less tar or nicotine do not reduce cardiovascular disease risk. Nonsmokers who are exposed to secondhand smoke (SHS) develop heart disease. It has been estimated that home exposure to SHS in the United Kingdom causes around 2,700 deaths annually among those aged 20-63 and an additional 8,000 deaths among those aged 65 and beyond. In addition, nonsmokers who are exposed to SHS may potentially get heart attacks and strokes.3

What is Angina?

Angina is chest discomfort resulting from decreased blood flow to the heart muscles. It is not generally life-threatening, but it is a warning indication that a heart attack or stroke is imminent. It is feasible to manage angina and lower the risk of these more severe complications with therapy and healthy lifestyle modifications. The primary distinction between angina and a heart attack is that angina is caused by constricted coronary arteries rather than blocked ones. In contrast to a heart attack, angina does not result in lasting cardiac damage.4

Types

Two primary forms of angina may be diagnosed:

  • Stable angina (more prevalent); attacks have a trigger (like stress or exercise) and subside after a few minutes of resting. 
  • Unstable angina (more severe); episodes are more unexpected (there may be no trigger) and may persist while resting. 

Some individuals acquire unstable angina after stable angina.4

Causes

Angina is often caused by a buildup of fatty substances in the arteries providing blood to the heart muscle. It is known as atherosclerosis. The following factors may raise your risk of atherosclerosis: 

  • Unhealthy nutrition. 
  • Insufficient exercise. 
  • Smoking. 
  • Increasing age. 
  • A familial history of atherosclerosis or cardiovascular disease.4

Symptoms

The primary symptom of angina seems to be chest discomfort. Typical causes of angina chest pain: 

  • It may extend to the arms, neck, jaw, and back if it is tight, dull, or heavy. 
  • It is prompted by physical effort or psychological strain. 
  • The pain ceases after a few minutes of relaxing. 

Occasionally, other symptoms may occur, such as nausea or shortness of breath.4

Diagnosis

The relevant medical professional indicates several tests are used to diagnose angina. Depending on the patient's stated symptoms, the diagnosing physician may do the following tests to confirm angina: 

  • Electrocardiogram (ECG). 
  • Echocardiogram. 
  • Chest X-ray Stress Test Blood Sample Tests. 
  • The procedure of coronary angiography.
  • Computerized Tomography of the Heart (CT) Scan. 
  • Cardiac Magnetic resonance imaging (MRI).5

Complications

If angina is not discovered and treated promptly, it increases the risk of cardiac arrest. Any kind of angina, if neglected and mistreated, might result in a heart attack at any time. According to experts, unstable angina and variant angina need rapid lifestyle modifications and medicines to reduce the risk of cardiac arrest.

People diagnosed with angina are typically advised to make certain lifestyle adjustments and use certain medicines. In addition to these, various modern medical treatments exist for angina, including coronary artery bypass surgery, angioplasty, and stenting. These medical treatments are undertaken if significant improvements cannot be obtained with recommended lifestyle modifications and appropriate medication.5

Effect of Smoking on Heart Health

Cigarette smoking may affect almost every body area, including the heart and blood vessels (cardiovascular system). When inhaled, the hazardous mixture of more than 7,000 chemicals in cigarette smoke may interfere with vital bodily processes that maintain normal function. One of these mechanisms is supplying oxygen-rich blood to the heart and the rest of the body. When you breathe, your lungs absorb oxygen and transport it to your heart, which pumps oxygen-rich blood throughout your body's arteries. However, when you inhale cigarette smoke, the blood transported throughout the body gets tainted with the toxins in the smoke. As a result, these substances may cause damage to the heart and blood arteries, which can result in cardiovascular disease.6

How Does Smoking Impact the Risk of Cardiovascular Disease?

Cigarette smoking may permanently harm the heart and blood vessels. This may result in cardiovascular illness. Multiple disorders that affect the heart and blood arteries are referred to as cardiovascular diseases. 

  • Coronary heart disease, or the constriction of the blood arteries that supply the heart with blood. 
  • Hypertension (high blood pressure). 
  • Cardiac attack. 
  • Stroke. 
  • Aneurysms (a bulge or weakness in an artery). 
  • A disease of the peripheral arteries. 
  • By altering the blood chemistry, cigarette smoking might potentially induce CVD.6 

These changes in blood chemistry may lead to the accumulation of plaque (a waxy substance composed of cholesterol, scar tissue, calcium, fat, and other substances) in your arteries which are the primary blood vessels that transport blood from your heart to the rest of your body. This accumulation of plaque may result in atherosclerosis. When cigarette smoke causes atherosclerosis and thicker blood in the arteries, it becomes more difficult for blood cells to go through arteries and other blood vessels to reach essential organs such as the heart and brain. This may cause blood clots, leading to a heart attack, stroke, or even death.6 

Other uncommon but dangerous cardiovascular diseases that smoking might induce include: 

  • Peripheral artery disease (also peripheral vascular disease): A disorder characterized by inadequate blood flow to the arms, legs, hands, and feet due to constriction of the blood arteries. Smoking is the principal avoidable cause of this ailment, which may lead to amputation.6 
  • An abdominal aortic aneurysm is a bulge that forms in the abdominal portion of the aorta, the primary artery that delivers blood throughout the body. The rupture of an abdominal aortic aneurysm might result in abrupt death. Aortic aneurysms kill more women than males, and virtually all fatalities from this disease are caused by smoking.6

Can Smoking Cause Angina?

Additionally, smoking stiffens blood vessels, making it more challenging to allow them to expand and contract as required and increasing their likelihood of rupturing. These alterations to the arteries may result in a heart attack, a stroke, or angina.7

Other Health Effects of Smoking

It may take a long time for smokers to develop a smoking-related illness or ailment. Consequently, some individuals assume it won't happen to them. Compared to nonsmokers, approximately two-thirds of long-term smokers will have an average life expectancy reduction of around ten years. There are also mounting indications that smoking is detrimental to mental health. Several studies have linked smoking to higher anxiety, panic attacks, depression, suicide attempts, and schizophrenia, among others. Tobacco use is the only risk factor shared by four major noncommunicable disease groups. These include cardiovascular illness, lung cancer, diabetes, and chronic obstructive pulmonary disease.

Smoking causes the vast majority of lung cancers and may cause cancer almost anyplace in the body. This consists of the lips, tongue, mouth, nose, esophagus, throat, larynx, stomach, liver, kidney, pancreas, bladder, blood, cervix, vulva, penis, and anus.

Chronic obstructive pulmonary disease (COPD), a severe, progressive, and debilitating disorder that restricts airflow in the lungs, is mainly caused by smoking. Furthermore, active smoking exacerbates asthma in active smokers and is related to an elevated risk of asthma in adolescents and adults.8 

Tobacco usage is a leading cause of cardiovascular diseases such as heart disease and stroke. The danger of blood clots, which restrict blood flow to the heart, brain, and legs, is increased by smoking. Due to smoking-related difficulties with blood circulation, some smokers are forced to have limbs amputated.8 

The risk of type 2 diabetes is 30 to 40 percent greater among active smokers than nonsmokers. Smoking may also exacerbate some complications of type 1 diabetes, such as renal damage.8 

Smoking diminishes your immune system, making you more susceptible to bacterial and viral diseases. 

The risk of gum disease, tooth loss, and tooth sensitivity is increased by smoking. In addition, once a person has gum disease, smoking makes it more difficult to recover. 

The inner ear receives less blood flow when a person smokes. As a result, smokers may also have hearing loss sooner than nonsmokers.8 

Smoking may induce macular degeneration, the leading cause of blindness in Australia.8 

Smoking might make pregnancy more difficult and reduce sperm quality. Learn more about the effects of smoking and tobacco on pregnancy.8 

Smoking is a risk factor for osteoporosis and may hasten menopause in women relative to nonsmokers.8

Help with Stopping Smoking

Once you have chosen your quit date, the NHS recommends some tips that may help you :

  • List all reasons to stop. 
  • Tell folks you're leaving. 
  • If you have previously attempted to stop, recall what worked. 
  • Use stop smoking aids. 
  • If you are compelled to smoke, have a strategy. 
  • List any smoking triggers and avoidance strategies. 
  • Prevent cravings under control by maintaining yourself occupied. 
  • Physical activity alleviates the craving. 
  • Join the group on Facebook for assistance and support.9

According to the NHS, the sooner someone stops, the sooner your body and health change. Consider what happens when stopping permanently. 

  • After twenty minutes, check your pulse; it will have begun to get back to normal. 
  • After eight hours, your oxygen levels will have recovered, and the amount of toxic carbon monoxide in the blood will have decreased by half. 
  • All carbon monoxide is washed out after 48 hours. As a result, your lungs eliminate mucus, and your perceptions of smell and taste are enhanced. 
  • If you have improved breathing after 72 hours, this is due to the bronchial tubes beginning to relax. Additionally, your energy will increase. 
  • After two to twelve weeks, the heart and muscles will get much more blood since blood circulation has improved. 
  • After three to nine months, your coughs, wheezing, and breathing issues will improve as your lung function rises to 10%. 
  • After one year: Fantastic news! The risk of heart conditions will be reduced by half compared to a smoker's. 
  • After a decade, more good news! Your chance of dying from lung cancer would be cut in half compared to a smoker's.9

Impacts of stopping smoking

Quitting smoking is one of the most crucial steps someone can take to better their health. This is true regardless of age or length of smoking history: quitting improves health status and quality of life. Smoking affects the blood and heart arteries very fast, although the damage is swiftly healed in most smokers who quit. Even heavy smokers may see dramatic health gains after quitting. Within a year, the risk of heart attack decreases considerably. Within five years, most smokers reduce their stroke risk to almost that of nonsmokers. Unfortunately, even just a few cigarettes sometimes harm the heart. Thus quitting is the only known technique to protect the heart from the consequences of smoking. 

Quitting benefits:

  • It reduces the risk of early mortality and may increase life expectancy by up to ten years. 
  • Reduces the chance of several undesirable health impacts, such as poor reproductive health outcomes, cardiovascular disorders, chronic obstructive pulmonary disease (COPD), and cancer. 
  • Beneficial for those with coronary heart disease or COPD. 
  • The health of pregnant mothers, fetuses, and infants is improved. 
  • Reduces the financial burden caused by smoking on smokers, healthcare systems, and society. 

While stopping smoking earlier in life has higher health advantages, quitting at any age is helpful to one's health. Even heavy smokers or those who have smoked for many years can benefit from stopping. In addition, quitting smoking is the most excellent method to protect your loved ones, colleagues, and friends from the health dangers of secondhand smoke.10

Summary

The lining cells of blood arteries become irritated and enlarged due to chemicals in cigarette smoke. This may restrict the blood arteries and result in various cardiovascular diseases. In addition, plaque narrows blood arteries, reducing blood flow. When a clot develops, the heart muscle suffers oxygen starvation.

References

  1. Smoking and Cardiovascular Disease [Internet]. HHS/CDC. 2014. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf 
  2. Facts and figures [Internet]. [cited 2022 Sep 22]. Available from: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/contact-the-press-office/facts-and-figures 
  3. Secondhand Smoke [Internet]. ASH. 2020. Available from: https://ash.org.uk/uploads/SecondhandSmoke.pdf 
  4. Angina [Internet]. NHS.uk. 2017 [cited 2022 Sep 22]. Available from: https://www.nhs.uk/conditions/angina/ 
  5. Angina: symptoms, complications, and treatment [Internet]. Practo. [cited 2022 Sep 22]. Available from: https://www.practo.com/health-wiki/angina-symptoms-complications-and-treatment/244/article
  6. Products C for T. How smoking affects heart health. FDA [Internet]. 2022 May 19 [cited 2022 Sep 22]; Available from: https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-affects-heart-health 
  7. Smoking and your heart I heart foundation [Internet]. [cited 2022 Sep 22]. Available from: https://heartfoundation-prod.azurewebsites.net/bundles/your-heart/smoking-and-your-heart 
  8. What are the effects of smoking and tobacco? [Internet]. Department of Health and Aged Care. 2020. Available from: https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco 
  9. Quit smoking - better health [Internet]. NHS.uk. 2020 [cited 2022 Sep 22]. Available from: https://www.nhs.uk/better-health/quit-smoking/ 
  10. CDCTobaccoFree. Benefits of quitting [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Sep 22]. Available from: https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm 

Sara Maria Majernikova

Bachelor of Science - BSc, Biomedical Sciences: Drug Mechanisms, UCL (University College London)
Experienced as a Research Intern at Department of Health Psychology and Methodology Research, Faculty of Medicine, Laboratory Intern at Department of Medical Biology, Faculty Medicine Biomedical Sciences Research Intern and Pharmacology Research Intern.

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