Cardiovascular Disease Is A ‘Smoking Disease’ – Dr Yap Jun Fai, Prof Dr Moy Foong Ming & Dr Lim Yin Cheng

Quitting smoking cuts the risk of cardiovascular disease dramatically.

Cardiovascular disease is an umbrella term which includes all types of diseases affecting the heart or blood vessels. It mainly consists of coronary heart disease (which may present acutely as a heart attack, stroke or heart failure).

According to a study from the United States, at least one in five male smokers or one in 10 female smokers will die prematurely due to a cardiovascular disease event.1

The same study also found that young smokers (aged between 20 and 40) are at least twice as likely as young non-smokers to die of a heart attack. 

Smoking is one of the most well-known behavioural risk factors for cardiovascular disease. Thousands of harmful chemicals are contained in cigarette smoke, which can lead to multiple adverse health effects. 

Besides being an addictive compound, nicotine in cigarette smoke may lead to abnormal blood thickening and subsequently, a higher chance of blood clot formation in major blood vessels.

Oxidative damage and narrowing of the blood vessel space may also occur. As a result, a heart attack can happen if a formed blood clot blocks the circulation in a coronary artery (which supplies blood to the heart muscle). 

Tobacco use doubles the risk in getting a heart attack.2 The co-existence of another major risk factor (such as diabetes, high blood pressure, high cholesterol, or obesity) may triple or even quadruple the risk.3

According to the National Cardiovascular Disease database, around 93 per cent of heart attack patients had at least one of the common cardiovascular risk factors. In the 2018-2019 registry report, up to 34 per cent of heart attack patients are current smokers, with an increasing trend of them being active smokers over the two years (from 33.9 per cent in 2018 to 34.5 per cent in 2019). 

Quitting smoking cuts the risk of cardiovascular disease dramatically. If a smoker quits and does not relapse during the next 15 years, the risk of coronary heart disease will decrease to that of a non-smoker.4

Research has also shown that mortality can be reduced by 36 per cent for ex-smokers with coronary heart disease, compared with smokers.5 If you smoke, please give it up as soon as possible by seeking professional medical help.

It was previously thought that heart attacks only affect older adults more often than young adults. Such assumptions may not apply fully these days, as young adults are potentially exposed to similar risk factors of cardiovascular disease.

Banning the sale of tobacco products (including vapes) to Malaysians born after January 1, 2007, means that those aged 18 years old (equivalent to the current legal age for smoking) or younger in two years’ time will not be allowed to purchase cigarettes or vaping products legally.

This effort, dubbed as the ‘Generational End Game’ by the Ministry of Health is commendable, and can reduce the number of young smokers in Malaysia.

Indeed, one of the best things you can do to maintain good cardiovascular health is not to use tobacco in any form (or quit smoking if you are already a smoker).


  1. Khan SS, Ning H, Sinha A, et al. Cigarette smoking and competing risks for fatal and nonfatal cardiovascular disease subtypes across the life course. Journal of the American Heart Association. 2021;10(23):e021751.
  2. Lakier JB. Smoking and cardiovascular disease. Am J Med. 1992;93(1a):8s-12s.
  3. Centers for Disease Control and Prevention (US). How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the surgeon general. 2010.
  4. Centers for Disease Control and Prevention (US). Reports of the Surgeon General. In: The Health Consequences of Smoking: A Report of the Surgeon General. 2004.5. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86-97.

Dr Yap Jun Fai, Prof Dr Moy Foong Ming and Dr Lim Yin Cheng are from the Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya and the Department of Public Health, University Malaya Medical Centre. The writers thank the National Heart Association of Malaysia for the current collaborative work.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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