A new report produced by WHO, the World Heart Federation and the University of Newcastle Australia for World Heart Day celebrated globally on 29 September, confirms a well-established causal link between tobacco smoking and morbidity and mortality related to coronary heart disease and urges all tobacco users to quit.

Every year, coronary heart disease, the leading cause of death and disability globally, causes the loss of 9.4 million lives. Of these, about 1.9 million (or approximately 21%) are attributable to tobacco use and exposure to second-hand smoke. Across the WHO European Region, where 26% of adults smoke, every fifth death from coronary heart disease was caused by tobacco use in 2017, accounting for approximately 480 000 lives lost.

The brief in a series of Tobacco Knowledge Summaries shows that smokers are more likely to experience an acute cardiovascular event at a younger age, and that the risk to heart health substantially increases even among occasional tobacco users or those who smoke only one cigarette per day. Furthermore, the evidence shows that all types of tobacco and nicotine products contribute to heart disease, with smokeless tobacco being responsible for around 200 000 annual deaths globally from coronary heart disease. E-cigarettes are also not harmless; their use raises blood pressure which increases the risk of cardiovascular disease.

Health benefits of quitting smoking

The effects of giving up smoking on heart health can be seen almost immediately:

• Within 20 minutes, heart rate and blood pressure drop.
• Within 12 hours, the carbon monoxide level in blood drops to normal.
• Within 2–12 weeks, circulation improves.
• A year after quitting, the risk of coronary heart disease is about half that of a smoker’s.
• 15 years after quitting, the risk of coronary heart disease is that of a person who never smoked.

Tobacco control interventions in the WHO European Region

The policy measures in line with the WHO Framework Convention on Tobacco Control, which are increasingly being adopted by countries in the WHO European Region, are proven to make a major difference to heart health. Increases in tobacco taxation, for example, have been directly linked with a reduction in tobacco consumption, thereby leading to better heart health.

Anti-tobacco media campaigns and graphic health warnings have also brought a better understanding of the dangers of tobacco use for heart health. Smoking cessation interventions are a cost-effective measure for preventing coronary heart disease and reducing both short-term and long-term health expenditure. The implementation of comprehensive smoke-free legislation also yields health benefits, including reported reductions in acute coronary events, tobacco-related hospital admissions and deaths.

Preventing coronary heart disease deaths caused by tobacco requires a comprehensive approach with multisectoral cooperation and the engagement of health systems. Health care providers, such as general practitioners, nurses, pharmacists and cardiologists, should raise awareness about the harms of tobacco and second-hand smoke to the cardiovascular system, as well as the benefits of quitting tobacco.