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Half of all tobacco-related deaths occur as a result of some form of heart disease. Smokers have a 70 percent higher death rate from heart disease than nonsmokers do, and heavy smokers have a 200 percent higher death rate than moderate smokers do. In fact, smoking cigarettes poses as great a risk for developing heart disease as high blood pressure and high cholesterol levels do.

Smoking contributes to heart disease by adding the equivalent of 10 years of aging to the arteries. One possible explanation for this is that smoking increases the development of atherosclerosis, the buildup of fatty deposits in the heart and major blood vessels. For unknown reasons, smoking decreases blood levels of HDLs (high-density lipoproteins), which help protect against heart attacks. Smoking also contributes to platelet adhesiveness, the sticking together of red blood cells that is associated with blood clots. The oxygen deprivation associated with smoking decreases the oxygen levels supplied to the heart and can weaken tissues. Smoking also contributes to irregular heart rhythms, which can lead to a sudden heart attack. Both carbon monoxide and nicotine in cigarette smoke can precipitate angina attacks (pain spasms in the chest when the heart muscle does not get the blood supply it needs).

The number of years a person has smoked does not seem to bear much relation to his or her risk for cardiovascular disease. If a person quits smoking, the risk of dying from a heart attack is reduced by half after only one year without smoking and declines gradually thereafter. After about 15 years without smoking, the ex-smoker's risk of cardiovascular disease is similar to that of people who have never smoked.

Stroke Smokers are twice as likely to suffer strokes as nonsmokers are. A stroke occurs when a small blood vessel in the brain bursts or is blocked by a blood clot, denying oxygen and nourishment to vital portions of the brain. Depending on the area of the brain supplied by the vessel, the stroke can result in paralysis, loss of mental functioning, or death. Smoking contributes to strokes by raising blood pressure, thereby increasing the stress on vessel walls. Platelet adhesiveness contributes to clotting. Five to 15 years after they have stopped smoking, the risk of stroke for ex-smokers is the same as that of people who have never smoked.

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