Smoking tobacco renders itself as a significant issue to health because of the numerous negative effects it has on the body, including coronary artery disease (CAD). Atherosclerosis is the buildup of plaque in arteries; coronary artery disease is atherosclerosis in the arteries that supply the heart with blood and over time can increase the potential for angina, heart attacks, heart failures, and arrhythmias (NHLBI, n.d). I chose to write about CAD because I could not comprehend how smoking tobacco can lead to plaque buildup in the arteries. Smoking is a relevant issue in the United States because it is the largest cause of preventable death and disease (Healthy People 2020, n.d.). About 480 thousand people per year die from complications due to smoking tobacco and about 16 million suffer from a disease caused by smoking (Healthy People 2020, n.d.). Smoking is also a global crisis, as it is one of the leading causes of preventable disease and death around the world (Sarna, Bialous, Chan, Hollen, & O’Connell, 2013). On an international scale, tobacco usage is responsible for about 100 million deaths (Sarna et al., 2013). It is important to educate both smokers and non-smokers about the risks that are associated with tobacco products, such as CAD, so that they live longer, happier, and healthier lives.
Natural History of Disease
CAD has plenty of risk factors that promote susceptibility because cardiovascular health is influenced by many elements. Non-modifiable risk factors include increasing age, the male sex, and heredity (American Heart Association, n.d.). Modifiable risk factors include: high total blood cholesterol, unhealthy triglyceride levels, high blood pressure, sedentary lifestyles, diabetes mellitus, smoking tobacco, and overweight and obesity (American Heart Association, n.d.). While there are many risk factors for CAD, cigarette smoking is a huge independent risk factor. An article titled “The association between tobacco smoking and coronary heart disease” states that, “Cigarette smokers have about twice as much coronary heart disease as non-smokers, whether measured by deaths, prevalence, or the incidence of new events” (Stallones 2015). Tobacco smoke damages the arterial lining and can contribute to magnifying other risk factors by increasing blood pressure, thickening the blood, and increasing cholesterol levels (Smoke Free, n.d.). Cigarette smoking plays an enormous role in developing CAD therefore must be avoided in order to live a healthy life.
Aside from the previously stated risk factors, susceptibility to CAD also includes those who are indirectly affected by means of second-hand smoke. An article titled, “Parental Smoking May Set up Children for Atherosclerosis” shows evidence that second-hand smoke puts many at risk for developing the disease. The study divided 494 thirteen year old children into three categories ranging from highest exposure to lowest exposure in regards to tobacco smoke and measured the following indicators of atherosclerosis: carotic and aortic intima-media thickness, flow-mediated dilation of the brachial artery, and plasma apolipoprotein A (ApoB) levels (Burton, 2010). The participants who were of high and intermediate exposure had thicker carotid and aortic intima-media and higher ApoB levels than those of low exposure (Burton, 2010). The low exposure participants had greater dilation in their brachial artery than those of intermediate and high exposure (Burton, 2010). Because of these findings, it is evident that those who are unprotected from second-hand smoke may develop atherosclerosis. There is no safe level of exposure to second-hand tobacco smoke (World Health Organization, 2018).
The etiology of the disease is the development of atherosclerosis in the coronary arteries (Ignatavicius, Working, & Rebar, 2017, p.771). In regards to CAD, atherosclerosis development occurs during the subclinical stage of the disease. Plaque consists of: fat, cholesterol, calcium, cellular waste products, and fibrin (American Heart Association, n.d.). This buildup causes the arteries to become narrow, weak, and less flexible, all of which are important to adequate blood flow (American Heart Association, n.d.).
The three stages of plaque development are: the fatty streak, plaque progression, and plaque disruption (Yelle, n.d.). The fatty streak stage is the earliest of all stages as plaque slowly begins to accumulate due to endothelial dysfunction from the cigarette toxins, allowing lipids into the artery’s subintima layer (Yelle, n.d.). Smoking contributes to endothelial damage because of the irritation it causes due to the carbon monoxide (Lano-Maduagu, CRB, EB, MU, & Onabanjo, 2015). With this damage, lipoprotein particles become trapped and accumulate in the vessel (Yelle, n.d.). Monocytes travel to the damaged endothelium and interaction with the lipids cause them to evolve into foam cells, which add to the plaque formation (Yelle, n.d.).
In the plaque progression stage, the tunica intima thickens due to the smooth muscle cells that migrate from the tunica media (Yelle, n.d.). This migration is a result of the cytokines and growth factors that are released by the foam cells, trapped platelets, and endothelial cells (Yelle, n.d.). As this cascade of events continues, the fatty streak grows into calcified plaque and blocks the pathway of blood (Yelle, n.d.).
The third stage, the plaque disruption stage, is also the clinical stage of the disease. In this part of CAD, the thrombus or fibrous part of the plaque detaches and travels into the bloodstream (Yelle, n.d.). Complications that arise from the third stage include angina, myocardial infarction, stroke, or an aneurysm (Yelle, n.d.).
Once diagnosed with CAD, one lives with the disease for the rest of their life. An individual’s condition may be facilitated via healthy lifestyle changes, medicines, and medical interventions and surgery for the severe cases (NHLBI, n.d.). Lifestyle changes benefit heart health such as maintaining a healthy weight, consistent physical activity, and the cessation of smoking (NHLBI, n.d.). These changes will allow for the heart to operate consistently within one’s normal range.
Medicines that are used to treat the disease are: statins to help improve total cholesterol levels, anti-lipids, blood pressure medications, anti-thrombolytics, and anti-inflammatories (NHLBI, n.d.). Because unhealthy cholesterol levels, high blood pressure, thrombosis, and the body’s inflammatory mechanism contribute to the maintenance of CAD, these respective medications assist in maintaining a healthy cardiovascular system.
Severe CAD may be treated with medical procedures; one method is coronary angioplasty, a procedure that opens a narrow or occluded artery by means of a stent, allowing blood to flow regularly (NHLBI, n.d). Coronary artery bypass grafting is another procedure in which a graft is used to provide alternative routes around the affected artery (NHLBI, n.d). With these procedures, it is essential that patient maintains a healthy lifestyle and continues to adhere to any prescribed medications in order to ensure their well being while living with CAD.
Epidemiological Characteristics
Coronary artery disease is the leading cause of death in regards to atherosclerotic complications in both adult men and women, regardless of whether or not they smoke (NIH MedlinePlus, n.d.). In the United States, CAD is prevalent in 15 million adults (John Hopkins Medicine, n.d.). The yearly incidence of the disease is 11.7 percent, or 28.4 million adult Americans (Centers for Disease Control and Prevention, 2017). Though preventative measures are stressed among those with unhealthy lifestyles and medical treatment is available, many do not survive the complications of CAD; smoking accounted for 33 percent of all deaths due to CAD (Centers for Disease Control and Prevention, 2010). In other words, CAD kills about 370,000 people annually (Centers for Disease Control and Prevention, 2017). This disease is an endemic to the United States because it is evident in many Americans, however between 2001 and 2011, the death rate has fallen about 39 percent (American Heart Association, 2015). The data included adults 18 years and older who have the risk factors for CAD, including smoking tobacco. As people continue to partake in unhealthy lifestyle choices, such as smoking tobacco, the incidence for CAD exists.
Smoking is an issue in other parts of the world as well, such as Canada. It is the number one preventable cause of death in Canada (Centre for Population Health Impact, 2017). About 13 percent, 3.9 million Canadians are current smokers (Propel Centre for Population Health Impact, 2017).
The 3.9 million Canadians that smoke are at risk for CAD. The yearly prevalence of CAD is 2.4 million Canadian adults 20 years and older (Public Health Agency of Canada, 2017.). The annual incidence for CAD is about 157 thousand people (Blais & Rochette, 2015). As people become aware of the risk factors for CAD the number of incidence decreases; it has decreased 46 percent between 2000/2001 and 2012/2013 (Blais & Rochette, 2015). As the incidence decreases, so does the morbidity of CAD. The mortality rate is 48 thousand (Public Health Agency of Canada, 2017.). This disease is an endemic to Canada because it is present but decreases in incidence and morbidity. Nonetheless, similar to the United States, as long as the risk factors for CAD exist amongst Canadians, so does the potential for one to develop the disease. The data presented includes adults 20 years and older who have the risk factors for CAD, including smoking tobacco.
According to the data, CAD seems to be more evident in the United States than Canada. Incidence and mortality is higher in the United States while prevalence is higher in Canada. There is, however, a slight difference in data because the American statistics included people ages 18 and older while the Canadian statistics included people ages 20 and older. Due to this, the comparison is not entirely accurate.
Applications of Epidemiological Research
It is evident that smoking tobacco leads to many health consequences yet many people continue to smoke because of nicotine, the addictive chemical ingested my smokers. As nicotine enters the bloodstream via tobacco smoke, it rapidly reaches the brain and releases adrenaline, allowing the user to feel pleasure and a jolt of energy (U.S. Department of Health and Human Services, 2017). Because the adrenaline rush is temporary and the body promptly develops a high tolerance for nicotine, addiction occurs; the user craves the adrenaline again. Nicotine is the underlying reason why smokers struggle to quit.
Because the fast addition makes quitting difficult, interventions have been invented in order to facilitate the process. One intervention that has been proven to help smokers cease smoking is the transdermal nicotine patch. This intervention delivers nicotine through the dermis at a steady rate (Wadgave & Nagesh, 2016). They are available in different dosages, allowing those trying to quit to wane their dependence until they feel that they can live a nicotine-free life. This method of nicotine replacement therapy is safe for long-term use and allows for quitters to achieve their goals in becoming tobacco free (Wadgave & Nagesh, 2016).
The transdermal patch has many positive characteristics, making it an effective intervention. One upside to this method of nicotine replacement therapy is that it is easy to use; a user simply applies it to their skin and does not have to worry about it for the day (Wadgave & Nagesh, 2016). Other interventions require attention, which might make adherence difficult for some users. Another benefit to the treatment is that the patch provides a steady amount of nicotine, allowing it to last longer than other therapies such as gums or lozenges which are short lived in regards to their therapeutic effects (Wadgave & Nagesh, 2016). More importantly, this form of treatment is the least addictive because of its gradual release of nicotine (Wadgave & Nagesh, 2016). For many, this is an effective treatment as they can decrease their dosages until they feel comfortable enough to live without nicotine and tobacco.
The transdermal patch also has many cons to it; one of the cons of this form of rehabilitation is that the user may have skin reactions (Wadgave & Nagesh, 2016). In order to avoid this, it is recommended that the user switches the placement of their patch. Another con is that the patch does not treat powerfully acute cravings for nicotine unlike the gum or lozenge. Therefore, uses may resort to other nicotine products while on the patch in order to satisfy that desire (Wadgave & Nagesh, 2016). This may cause an episode of relapse if the user is unable to handle their strong nicotine cravings. Nicotine overdose is possible if one smokes or uses another form of nicotine replacement therapy while on the patch. Additionally, sleep disturbances are another side effect of the patch, especially for those who wear them for 24 hours (Wadgave & Nagesh, 2016). There are various pros and cons to consider when decided which form of nicotine replacement is appropriate; nonetheless, the nicotine patch has been proven to be effective in helping many live tobacco-free (Wadgave & Nagesh, 2016).
Methods of intervention are similar in developed countries such as the United States and Canada; the two offer counseling services, non-prescription nicotine replacement therapies, and prescription therapies. Developing countries, such as Nigeria, have similar forms of interventions. The country offers non-prescription nicotine replacement therapies such as the patch, gum, lozenge, and inhaler (World Health Organization, 2017). Medication, such as Bupropion, an antidepressant that is used to help people stop smoking, is also available in this country via prescription (World Health Organization, 2017). Health insurance and over national support systems partially cover the costs for these medications and medical visits concerning tobacco. Furthermore, counseling and support services are partially offered in places such as hospitals and health professional offices. Smoking tobacco has been recognized as an issue and thus, Nigeria has made interventions similar to that of developed countries available for their people.
Conclusion
Smoking tobacco is a huge risk factor to coronary artery disease because of the negative effects it has on the cardiovascular system. The toxins and nicotine that is consumed damages the endothelium of the coronary arteries, allowing for plaque to accumulate and cause complications. Interventions such as the transdermal nicotine patch have been proven to help current smokers, quit by relieving their nicotine addiction, which is the underlying reason behind smoking tobacco. Because smoking renders itself the largest risk factor for developing CAD, the best method of intervention would be to avoid smoking tobacco all together (Stallones 2015). Through education, the number of smokers will decrease and so will the incidence and prevalence of CAD. It is essential that we educate clients in the negative health effects of smoking tobacco in order to help others live longer, healthier, and happier lives.
2018-3-19-1521424043