…Over 6 million die annually

By Chioma Obinna

Smoking kills! Tobacco product is one consumer product guaranteed to kill its user even when it is used as directed. Today, tobacco epidemic is one of the biggest public health threats all over the world.  According to the World Heart Federation, WHF, smoking is estimated to cause 10 per cent of cardiovascular disease, CVD, and is the second leading cause of CVD, after high blood pressure.

Sadly, the impact of tobacco smoke is not confined solely to smokers. Every year, nearly six million people die from tobacco use or exposure to second-hand smoke, accounting for  six  percent of female and 12 per cent of male deaths worldwide.

By 2030, tobacco-related deaths are projected to increase to more than  eight  million deaths a year.

Tobacco smoke contains a deadly mix of more than 7,000 chemicals. Hundreds are toxic. About 70 are known to cause cancer.   According to medical experts, none of these chemicals in tobacco has an overall health benefit.

Statistics by the World Health Organisation  (WHO)  show that tobacco caused 100 million deaths in the 20th century. Estimates say it may cause one billion deaths in the 21st century.

Despite the fact that life expectancy for a smoker is at least 10 years shorter than for a non-smoker, many lives of non-smokers are put at risk due to second-hand smoke.

Sunday Vanguard  X-rays the impact of smoking on heart health and why it remains an avoidable risk factor for heart diseases.

When the late former Minister of Health, Professor Olikoye Ransome-Kuti, began his  anti-smoking campaign in 1989, not many saw it as an important campaign but his tenure  proved them wrong as it brought about a law against smoking. Cigarette manufacturers were also compelled to carry warnings such as “Cigarette smokers are liable to die young,” and “The Federal Ministry of Health warns that tobacco smoking is dangerous to health.

Since then, warnings on cigarette packs  such as “Smoking causes lung cancer, heart disease, and emphysema and may complicate pregnancy”, “Smokers are liable to die young” and “Quitting smoking now greatly reduces serious risks to your health” have become  widespread.

Although  this singular effort brought some level of sanity, smoking have become  in public places persists despite the breakthrough Nigeria   achieved when it secured the passage of Tobacco Control Act. Nigeria is one of the three largest tobacco markets in Africa, others being Egypt and South Africa. Tobacco sales in Nigeria have continued for a  long time with profits of  tobacco companies increasing year on year. Although there are no records of consumers in Nigeria, a 2012 WHO report  estimated that Nigeria has a population of almost 13 million smokers, and 18bn cigarettes are sold each year at a value of about $931m (N185 billion).

However, smoking, according to medical experts is, avoidable. To them, strict implementation of 100 percent  smoking-free environment will save over 600,000 non-smokers’ lives lost to tobacco due to exposure to second-hand smoke.   While smoking harms the smokers’ health, it also puts lives of people around in danger because they inhale the smoke exhaled.

According to  Senior Programme Officer, Civil Society Legislative Advocacy Centre, CISLAC, Okeke Anya, it is ripe for the discouragement of smoking, encouraged stoppage of tobacco products through catalytic measures like 100 percent smoking-free environment.

How tobacco causes cardiovascular disease

According to the World Heart Federation, WHF, tobacco acts in a number of ways to cause CVD. Its use, whether by smoking or chewing, damages blood vessels, temporarily raises blood pressure and lowers exercise tolerance.  Tobacco  also  decreases the amount of oxygen that the blood can carry and increases the tendency for blood to clot.   These clots, when formed in the arteries, cause a range of heart diseases that ultimately result in stroke or sudden death.   WHF report shows that the risk for coronary heart disease is 25 per cent higher in female smokers than in male smokers while the risk of a non-fatal heart attack increases by 5.6 per cent for every cigarette smoked and persists even at only one to two cigarettes per day.

Also, chewing tobacco more than doubles the risk of heart attack. Despite this  dangerous twist, awareness of links between smoking and cardiovascular disease remains low in many parts of the world including Nigeria.

The  Vice President, World Heart Federation/African Heart network, Dr. Vash Mungal-Singh, said the risk increases with the number of cigarettes smoked and has been reported to increase the incidence of MI 6-fold in women and 3-fold in men compared to non-smokers.

“The chemicals in tobacco smoke harm blood cells and can damage the function of the heart and the structure and function of blood vessels. This damage increases the risk of atherosclerosis. Smoking decreases the tolerance for physical activity and increases the tendency for your blood to clot. Risk for heart disease increases greatly if one smokes and have a family history of heart disease”, he stated.

“Smoking is also an important risk factor for stroke. Inhaling cigarette smoke produces several effects that damage the cerebrovascular system. Women who take oral contraceptives and smoke increase their risk of coronary artery disease and stroke significantly. Over time, CAD can lead to chest pain, heart attack, heart failure, arrhythmias or even death. Smoking by itself is a major risk factor for heart disease. When combined with other risk factors—such as abnormal cholesterol levels, high blood pressure, overweight, or obesity and/or diabetes —smoking further raises the risk of heart disease. Smoking also is a major risk factor for peripheral arterial disease (PAD).

“It is also important to avoid other people’s smoke. The link between secondhand smoke and heart disease is well known. Each year about 38,000 people die from heart and blood vessel disease caused by other people’s smoke. Non-smokers exposed to secondhand smoke at home or at work increase their risks of developing heart diseases by 25 to 30 percent.”

Mungal-Singh  advised that it would do a lot of good to quit smoking if an individual already has heart disease, as the lungs can begin to heal themselves as soon as one stops harming them with more smoke.

She called for political will and a firm commitment from health leaders to put in place some progressive strategies to stop tobacco smoking.

According to her, to protect citizens from unnecessary deaths, there is need for government to implement policies and programmes that would ensure smoke-free indoor work places, public places and public transportation.

Reducing effects of smoking

On his part, a renowned Cardiologist, Dr. Kingsley Akinroye, said tobacco smoking is harmful as it affects almost every organ in the body, hence the need for people to be educated on the dangers of smoking.

Akinroye, who is also the Executive Director, NHF, said: “Also smokers are at higher risk of developing pneumonia, tuberculosis, and other airway infections.  It also causes inflammation and impairs immune function. Smoking makes it harder for a woman to get pregnant. A pregnant woman who smokes is at higher risk of miscarriage, having an ectopic pregnancy, having her baby born too early and with an abnormally low birth weight, and having her baby born with cleft lips and cleft palate.  A woman, who smokes during or after pregnancy, increases her infant’s risk of sudden-infant- death-syndrome. “Men, who smoke, are at greater risk of erectile dysfunction. Cigarette smoking and exposure to tobacco smoke cause many premature deaths each year in Nigeria. Smoking is the leading cause of premature, preventable deaths in Nigeria and Africa at large. However, the good news is that regardless of their age, smokers can substantially reduce their risk of diseases, including cancer by quitting smoking”.

He  called for effective enforcement of the Tobacco Control Act passed by the 7th Assembly and signed into law in 2015.

The  cardiologist, who expressed worry on the rise in tobacco smoking among school children and the delay in the implementation of the Tobacco Control Act, urged smokers to quit the habit to avoid becoming a victim. He said only few African countries have honoured their own pledge by ensuring that all tobacco sold has no brand name on the packaging. “The Federal Government should take a cue from those few countries as the giant of Africa. It is all about the President making a pronouncement that we have to honour the treaty that we signed. Number two, we now have a tobacco law in the country.   Are we honouring the law former President Goodluck Jonathan signed in 2015? One of the ways we can honour a law is by empowering the agencies for implementation and also funding is very important.”

Senior Program Officer, CISLAC, also said  to reduce tobacco consumption in Nigeria, there was need for the introduction of high price and tax measures.

“Intake of tobacco and cigarette has caused a lot of harm to the health of Nigerian citizens and we all pay for it in one way or the other,”he said.

“The enactment of a strong tobacco control law is an important step but legislation alone does not signal the end of a policy advocacy campaign journey.

“The law must be effectively implemented to achieve its public health goals. In most countries, once a law is passed, regulations must be developed. Therefore, a plan for implementation is essential.

“There is need to prohibit certain unnecessary interaction between government and tobacco industry.     Where interactions are necessary, ensure there is transparency, prevent conflict of interest between, and within government and tobacco industry”.



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