KUALA LUMPUR, Nov 11 — Most people know that smoking and vaping are harmful. But they never realise the extent of its effects beyond the lungs.
Long before the symptoms appear, it may already affect their kidneys, brain and their vital organs, setting the stage for a heart attack they never saw coming.
For most Malaysians, both acts are still seen as a lung habit, something that causes a cough, or perhaps cancer down the line. But doctors who work at the frontlines of respiratory and emergency medicine say the damage runs far deeper, and starts far earlier, than most people realise.
According to the Ministry of Health’s (MOH) National Health and Morbidity Survey (NHMS) 2023, approximately one in five (19 per cent) Malaysian adults still uses tobacco products.
Among those aged 15 to 24, e-cigarette use is climbing sharply. Behind those numbers lies a growing burden of non-communicable diseases (NCDs), heart attacks, strokes, kidney failure, and chronic lung disease, that both smoking and vaping quietly fuel.
How Smoking Is A Whole-Body Disease
Dr Syed Ajmal Syed Ali, respiratory physician and interventional pulmonologist at Sunway Medical Centre (SMC) is direct about the misconception. “Smoking is best understood as a systemic disease process, not a single-organ problem.
“When you inhale a cigarette or a vape, more than 7,000 chemicals can enter the bloodstream and travel throughout the entire body. The lungs are just where the story begins.”
Those chemicals attack the inner lining of blood vessels, triggering atherosclerosis, the narrowing and hardening of arteries that raises the risk of heart attack and stroke.
Smoking also makes blood clot more easily, and carbon monoxide from cigarette smoke displaces oxygen in the bloodstream, meaning the heart and brain are running on less fuel every single day.
Beyond the cardiovascular system, smoking accelerates kidney damage, suppresses the immune system, and drives chronic inflammation that quietly primes the body for disease.
The shift in patient age has been striking. Chronic Obstructive Pulmonary Disease (COPD), a progressive, irreversible lung condition was once a disease of the elderly.
“If you start at 15 or 16, by the time you are 35, you have nearly two decades of cumulative damage. The harm is there, it just has not yet shown up on a scan. That is not reassurance, that is a warning,” said Dr Syed Ajmal.
From Clinic To Crisis, An Emergency Time Bomb
Dr Ian Tey Zhe Yuan, emergency medicine physician at SMC, encounters the consequences directly. “When a patient comes in for an emergency episode of heart disease or stroke, we will stabilise and review the history, smoking may be part of their medical history, alongside diabetes, hypertension, family history.
“It is one of the biggest risk factors in the room. And unlike age or genetics, smoking habits are the only factor a patient can change.”
Heart attacks, severe COPD episodes, acute asthma, pneumonia and acute limb ischaemia are among the emergencies Dr Ian most frequently links to smoking. He has also watched the age of these patients slip.
“Being young no longer gives you a free pass. The idea of serious cardiovascular diseases will only happen to older people simply does not hold anymore,” he said.
The Malaysian National Cardiovascular Disease Database (NCVD) confirms it, rates of acute coronary syndrome among patients under 45 years old are rising, with smoking acting as a key independent risk factor.
The Vaping Illusion
Many young Malaysians have turned to vaping or heated tobacco products believing them to be safer alternatives. Both doctors are unequivocal: they are not.
“With heated tobacco, you are still inhaling carcinogens, the amount may be lower, but it accumulates. With vaping, we may not understand the full damage for another 10 to 20 years,” said Dr Syed Ajmal.
According to him, vape liquids contain chemicals that change when heated, many potentially carcinogenic. Nicotine concentrations may also be often higher than in cigarettes, creating stronger dependency in younger users.
“There is no safe amount of smoking and vaping. The body does not make that distinction,” said Dr Tey.
It Is Never Too Late
The most important message shared by both doctors is that quitting smoking as soon as possible opens the door to better health, regardless of how long you have smoked.
Within 24 hours of stopping, carbon monoxide clears and oxygen delivery improves. Within weeks, circulation strengthens. Within a year, heart attack risk falls by approximately 50 percent. Within five years, stroke risk drops significantly.
“Even after decades of smoking, stopping delivers real, measurable benefit, the body can respond sometimes almost immediately,” said Dr Syed Ajmal.
Both doctors stress that quitting is not about willpower alone. Nicotine creates real physical dependency, and withdrawal is genuinely difficult.
Evidence-based support, nicotine replacement therapy, prescription medications, and structured quit programmes can significantly improve success rates. There also resources available by the MOH, online, at clinics, or even at some retail pharmacies to help Malaysians kick the habit.
Some hospital pharmacies also may offer a one stop-smoking professional counselling aid.
For those above 50 years old with a significant smoking history, Dr Syed Ajmal recommends annual low-dose CT (LDCT) lung cancer screening.
“Even if you quit years ago, screening matters. The risk does not return fully to baseline but catching lung cancer early may change your health outlook,” he said.
“Smoking is not just a lung habit. It is a whole-body risk. The good news is that stopping, today and not someday, is one of the most powerful things a person can do for their health,” concluded Dr Tey.
