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No half measures for smokers30 November 2006 Cutting down on smoking makes no difference to the long-term risk of dying from cardiovascular disease or smoking-related cancers, the results of a large Norwegian study indicate. During an average follow-up of 21 years, heavy smokers who reduced the amount they smoked by half or more had the same health risks as heavy smokers who didn't cut down at all. The research, published in the December issue of Tobacco Control, suggests that advice to cut down may give "false expectations" to smokers who haven't quit, claim authors Aage Tverdal and Kjell Bjartveit (Norwegian Institute of Public Health and the National Health Screening Service, in Oslo, Norway). What's so bad about smoking?Tobacco smoke contains nicotine, which is addictive, as well as a whole range of other harmful chemicals, including the poisons carbon monoxide, formaldehyde and hydrogen cyanide. It even contains small amounts of the radioactive isotope polonium-210, recently implicated in death of former KGB agent Alexander Litvinenko. Smoking causes the narrowing and hardening of artery walls (atherosclerosis). It also tends to increase levels of cholesterol in the blood, and raises levels of the blood clotting factor fibrinogen. All of these effects combine to increase the of risk coronary heart disease (CHD) - diseases that stop the heart muscle getting enough blood supply. Tobacco smoke is also a carcinogen, which means it can give you cancer. Because of these reasons, smoking is associated with a very long list of diseases and health problems including:
Smoking can also affect your sense of taste and sense, and cause premature wrinkling of your skin. What did the researchers do?For their study, Tverdal and Bjartveit recruited over 51,000 men and women in the mid 1970s, and screened them for risk factors for cardiovascular disease, including smoking habits. The volunteers, who were aged between 20 and 49 years when they enrolled, were then screened at least once more between three and 13 years later to re-assess how much they smoked. The researchers then grouped the participants according to smoking habit, and looked at how common smoking related deaths were, up to the end of 2003. Volunteers who smoked 15 or more cigarettes a day were classed as heavy smokers. Those who were heavy smokers at the first screening, but who had cut down by 50 percent or more at the second screening were classed as "reducers". What did they discover?For both men and women, there was no difference in the incidence of death from all causes between heavy smokers and reducers. The relative risks for cardiovascular and heart disease were the same among heavy smokers and reducers. While there were some differences in the relative risks for smoking-related cancers such as mouth or throat cancer, and for lung cancer, they weren't large enough to be beyond chance. What about those who quit?Volunteers who gave up before or during the study had a substantially reduced risk of death compared to those who continued smoking. Why is this so important?For some smokers it is tempting to think that, if you can't quit, cutting down is the next best thing. Some health advisers and patient counsellors may present this option as a "last resort" to smokers who have been unsuccessful in giving up. But these results challenge that view. "The study proves quite clearly the only safe way out of the risk caused by smoking," the authors explain. "People who quit smoking have achieved a risk level that is remarkably lower than in those who continued to smoke." So for smokers the message is clear - stop smoking completely and dramatically reduce your risk of an early death. Further Information
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