World Tobacco Day and the National No Tobacco Week which were observed recently highlighted an aspect in smoking which is often sidelined by other more commonly known adverse impacts of tobacco smoking; namely, its equally devastating effects on the cardiovascular system.
According to the World Health Organisation, nearly 12 % of cardiovascular deaths worldwide occur due to tobacco abuse and second hand smoking. Researchers have said that in tobacco cigarette, there is a combustion, a burning of an organic material that generates temperatures up to 900 degree celcius. Chronic exposure to this tends to thicken blood vessels making them weaker in the long run. This can lead to blood clots and ultimately result in stroke or peripheral heart diseases, they noted.
Researchers have pointed out that inhaling the smoke from tobacco builds up fatty material in the heart of the smoker which then damages the inner lining of arteries and also narrows them further. This can cause angina, stroke or heart attack, they said.
To gain more insight into both, how tobacco smoking impacts on the heart, and how it affects and leads to oral cancer and lung cancer, the Sunday Observer sought the views of two eminent specialists in these respective fields , for their views on the subject .
They are, Consultant Cardiologist & President of the Heart Association of Sri Lanka, Dr. M.R. Mubarak, and Consultant in Community Dentistry, Institute of Oral Health, Maharagama, and Convener, Smokeless Tobacco Project Committee, NATA, Dr Hemantha Amarasinghe. Dr Amarasinghe is also a member of the Expert Committee on Tobacco, Alcohol and Illicit product, Sri Lanka Medical Association (SLMA)
Excerpts :
Impact of tobacco smoking on the heart based on our discussion with Dr.M.R.Mubarak
Q. The global tobacco epidemic which kills over 7 million people annually has raised serious concerns among health authorities everywhere. The fact that close to 900,000 are non smokers dying from breathing second hand smoking has underscored the gravity of lung cancer, now on the rise . However this year’s World No Tobacco Day was about Tobacco and Heart Diseases. What is the link between tobacco smoking and cardiovascular diseases?
A. Smoking tobacco is a major risk factor for cardiovascular disease. Smokers are almost twice as likely to have a heart attack compared with people who have never smoked.
Q. If you go by percentages, how many people die of cardiovascular diseases directly due to tobacco use? Has there been any study on this globally and locally?
A. Smoking is associated with around 7 million global deaths per year, directly related to the consumption and exposure to smoke. 30% of all heart disease deaths are caused by cigarette smoking.
Q. Tobacco use is said to be the second leading cause of CVD after high blood pressure. What is the position in Sri Lanka?
A. Yes, tobacco is the second leading major risk factor of Cardiovascular disease after high blood pressure.
Q. What are the symptoms one must look for early detection of a heart attack or stroke due to breathing in tobacco smoke or smoking tobacco?
A. Common heart attack symptoms are sudden tightness, pain, pressure or squeezing sensation in the chest, may spread to the arms, neck, jaw or back. Heartburn and nausea, shortness of breath, cold sweat and dizziness.
Act immediately. If you suspect you are having a heart attack, immediately seek emergency medical advice. DO NOT DELAY.
Q. Is it correct that smokers are almost twice as likely to have a heart attack than people who have never smoked? If so is it due to the 400 odd chemicals in tobacco smoke that damage the linings of our arteries, Or reduces oxygen in the blood? .
A. Smokers are exposed to more than 400 chemicals, Tar, Nicotine, Carbon monoxide, Nitrogen oxide, Hydrogen cyanide, metals, Ammonia etc. Smoking damages the lining of arteries (endothelium) leading to build up of fatty material on the arterial wall (atherosclerosis) which narrows the arteries. Nicotine which is addictive stimulates the body to produce the hormone adrenaline which makes the heart beat faster (arrhythmia) and raises the blood pressure.
The carbon monoxide in smoke reduces the amount of oxygen in the blood causing polycythemia. The blood is more likely to clot (thrombosis), sudden clogging of the arteries leading to heart attack, stroke and sudden death.
Q. How can you protect your heart from tobacco smoke?
A. Stopping smoking is the single best thing to protect your heart. This includes avoiding secondary smoking.
Secondary smoking also known as passive smoking is involuntary inhalation of non-smokers of the smoke produced by someone smoking around them.
Q. Is there a help line for smokers as in other countries?
A. Yes, Call 1948
Impact of tobacco smoking on oral cancer based on our discussion with Dr Hemantha Amarasinghe
Q. Betel chewing is a deeply ingrained habit among our people, especially, in the villages and the estate sector As a specialist in the field of dental carcinoma, tell us of the impact of betel chewing which is now on the rise due to once imported commercial preparations being produced here illicitly, like mawa, gutka, panarag, babul and beeda which are mostly demanded by young people. How do these affect our oral cavity, oro pharynx and oesophagus?
A. Betel quid and other commercial preparation like mawa, babul beeda contains tobacco, and arecanut which release carcinogens while chewing. Once it is absorbed into the mucosal cells of oral cavity, pharynx and oesophagus results in mutations of the gene ending up with cancer. A mutation is the permanent alteration of the gene in nucleas. Tobacco releases 28 carcinogens and arecanut releases 4 carcinogens when chewing.
Q. Will they all end up with cancer ?
A. All those using these products will not develop cancer. However, more than 95% of the patients having cancer of the oral cavity, pharynx and oesophagus are addicted to betel chewing, smoking or alcohol use.
Once mutations occurr in the gene of the nuclease of the affected mucosal cells due to tobacco and arecanut or any other risk factor, there are 1,000 mechanisms to stop it progressing to cancer.
Among them onco-supperssor gene activity, immunity and other DNA repair activities are prominent modes of actions to prevent developing cancer. There is an individual variation of these mechanisms which will decide the cancer formation. Therefore, one can develop cancer with risk factors while others may not develop cancer.
Q. What are the symptoms of diseases due to these illicit products?
A. When using these products you may develop pre-cancer of the affected site which is manifested by: white, red patches, burning sensation of the mouth, blanching and whitening of the lips, mucosa and tongue. Sometimes, there is difficulty of opening the mouth and swallowing, ulcer or swelling may develop once it progresses into frank carcinomas
Q. What is the treatment?
A. If it’s detected at the pre-cancer stage, it could be treated and cured if they quit the habit. Surgery, chemotherapy or radiotherapy is indicated for treatment of carcinomas.
Q. For those affected in an advanced stage what is the prognosis?
A. If detected at the late stages 50% of the patients die within 5years.
Q. What are the latest figures on the Cancer Registry regarding oral and lung cancer ?
A. According to the latest published cancer registry 2,422 oral cancer patients registered for treatment during the year 2010, which is 14.27% of the total reported cancers in Sri Lanka. Oral cancer is the number one cancer among male and 5th among females. One in every 64 individuals carry a lifetime risk of developing oral cancer in the country. 1,015 lung cancer patients were registered during the year 2010, which is 6% of the total reported cancers. Lung cancer is the 2nd leading cancer among males and one in 143 individuals are carrying a lifetime risk of developing lung cancer.
Q. Is there preventive legislation that can end imports of illicit cigarettes?
A. Yes, Sri Lanka is the only country in this region which ratified the WHO Framework Convention on Tobacco Control protocol to eliminate illicit trade in tobacco products in January 2016 and is additionally obliged to combat cigarette smuggling nationally.
Q. What is the State and Ministry of Health doing about it?.
A. Several amendments were approved by the Cabinet of Ministers to implement the above mentioned legislation. Amendments were pending for Parliamentary approval.
Q. With all these measures, advertising tobacco products still continues with impunity, at school matches, rugby and cricket tournaments, etc. Your comments?
A. Schoolchildren need to be protected from cigarette, tobacco, areca nut preparations, alcohol and other drugs. School authorities should take maximum effort and it should be their utmost responsibility to prevent these things happening at special events.
Q. Your message to the public?
A. Smoking, alcohol use, betel chewing and arecanut use are the major killers of Sri Lankan population, and contribute to major economic loss. Tobacco smoking will have a major impact on environmental changes taking place at present. Therefore, all individuals, societies, ministries and departments should collectively take maximum effort to control of these addictive substances.