Cigarette smoking is the most important preventable cause of premature death in the United States. It accounts for about 417,000 of the more than 2 million annual deaths. Cigarette smokers have a greater risk of developing chronic disorders such as atherosclerosis (ath"er-o-skleh-RO'sis), several types of cancer and chronic obstructive pulmonary disease. Atherosclerotic cardiovascular disease (clogged arteries) is the chief contributor to the excess deaths from smoking. Many studies detail the evidence that cigarette smoking is a major cause of coronary heart disease, which leads to heart attacks.

What are the risk factors for heart attacks?

Cigarette and tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes are the six major, independent risk factors for coronary heart disease that you can change, treat or modify. Cigarette smoking is so widespread and significant as a risk factor that the Surgeon General has called it "the most important of the known modifiable risk factors for coronary heart disease in the United States."

A relationship exists between cigarette smoking and the risk of coronary heart disease. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. Cigarette smoking is the most important risk factor for both young men and women. It produces a greater relative risk in persons under 50 years of age than in those over 50 years old.

Women who smoke and use oral contraceptives greatly increase their risk of coronary heart disease compared with women who neither smoke nor use oral contraceptives.

The ratio of high-density lipoprotein cholesterol to low-density lipoprotein cholesterol is lower in cigarette smokers than in nonsmokers. Cigarette smoking combined with a family history of heart disease also seems to greatly increase the risk.

What about cigar and pipe smoking?

People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (possibly stroke), but their risk is not as great as cigarette smokers. This is probably because they are less likely than cigarette smokers to inhale the smoke. There is very little scientific information on cigar and pipe smoking and cardiovascular disease at this time; after more studies are done, more will be known.

What about passive or secondhand smoking?

The AHA also believes more study is needed of the effects of passive smoking (also called secondhand smoke and environmental tobacco smoke) on heart and blood vessel disease in nonsmokers. Several studies already document the health hazards posed by passive smoking. It’s estimated that from 37,000 to 40,000 people die from heart and blood vessel disease caused by other people’s smoke each year.