Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


Look at the back of your hand - then make a fist. lf you're an adult, the size of your fist is about the size of: your heart.

Next, observe the veins on the back of your hand. They are bluish and stand out in relief. They look somewhat like the coronary arteries, which are located on the surface of the heart and send branches deep into the heart muscle itself. In this manner the cells in the heart muscle receive their supply of oxygen, as well as other nutrients.

When these arteries harden, the condition is known as "arteriosclerosis," and many adults suffer from it today. A number of factors contribute to this condition. Among', the main offenders are high blood pressure, high cholesterol levels smoking, and probably stress, all of which contribute to the depositing of cholesterol, fibrin. and other substances in the walls of the artery.

When this condition afflicts the coronary arteries it usually announces itself through chest pain, known as angina. Sometimes however, the first warning is a heart attack, which may prove fatal.

Coronary arteriosclerosis is usually treated with medication. However, at times the cardiologist has to examine the patient and perform tests to determine precisely where in the artery blockage is occurring, At this point, he may choose to recommend one of two "revascularization techniques" - either an operation on the heart or expansion of the artery by using a laser technique or by the insertion of a collapsed balloon at the end of a catheter, which is then inflated to expand the artery.

This latter technique is called "angioplasty'', and last year doctors used this procedure on almost half a million Americans. (Incidentally a comparable number underwent heart surgery.)

Angioplasty is an effective treatment and many people receive immediate relief as result. However, in a sizable percentage of patients. the narrowing of these arteries recurs. As a consequence, many require an additional angioplasty, or else major heart surgery. Were it not for the high incidence of recurrence, doctors would perform more angioplasties and less surgery. In fact, perhaps 90 percent of all heart operations would prove unnecessary if angioplasty worked all the time.

So why doesn't it? The Mayo Clinic came up with one possible answer --- smoking. Not that this it's the only answer but it is an important factor.

This interesting but predictable conclusion appeared in a recent article by David Hasdai, MD. and several other researchers (The New England Journal of Medicine Vol 336, No. 11, pp 755-7760, March 13, 1997) The authors reviewed all revascularization procedures performed at the Mayo Clinic between 1979 and 1995 The patients were divided into several groups according to their smoking habits. The "non-smokers'' numbered 2,009. "Former smokers'' (those who stopped prior to the procedure) numbered 2,759. "Quitters'' (those who stopped smoking after the procedure) numbered 435. The last group. "persistent smokers`' (those who smoked before and after the procedure) numbered 734.

In their analysis, the researchers compared results in the various groups and found that persistent smokers were at a greater risk of death than those who did not smoke or had stopped smoking. The final sentence summarizes their conclusion: "Our results demonstrated that after successful percutaneous interventions, patients who continue to smoke have a 44 percent greater risk of death from any cause as compared to those who quit smoking."

This is a sweeping statement, since it includes all causes of death - heart disease, cancer, whatever, If you smoke, a lot of things are more likely to get you.

:But there's another point that may be even more important: the death rate was greater among smokers over a relatively short span of time - sixteen years at the maximum. It didn't matter whether doctors employed balloon angioplasty or laser angioplasty. The death rates were the same. So the differentiating factor was clearly smoking

Of course, doctors have known for a long time that smokers have a much higher incidence of coronary artery disease than non-smokers. For example, research indicates that heart attack patients who smoke are much more likely to die than those who don't smoke. Also, earlier studies have demonstrated that the onset of chest pains due to angina occurs approximately ten years earlier in smokers

This recent study of angioplasty patients is one more piece of a jigsaw puzzle whose meaning is now clear: People who smoke are slowly committing suicide.

If you're still smoking you should quit - right now Throw your cigarettes away and don't ever buy or borrow another one. Virtually every medical study confirms what Americans have known for almost a half century - tobacco is a poisonous substance If you use it, you're probably going to die quicker and perhaps more painfully than people who don't.

This article is for general information purposes only. Readers with specific problems should see their doctors

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