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The Impact of Smoking on Heart Health

Cigarette smoking has been linked to over 27 chronic diseases, including lung disease, cardiovascular diseases, cancers, and diabetes. It is the predominant cause of lung cancer and chronic obstructive pulmonary disease (COPD).1 In the U.S., about 26 million adults live with smoking-related diseases.2

Cardiovascular disease (CVD) encompasses various medical conditions affecting the heart or blood vessels. Examples of cardiovascular disease include:

  • Coronary heart disease: heart attacks, coronary vessel disease, angina
  • Cerebrovascular disease: strokes, aneurysms, and emboli
  • Heart valve disease
  • Congenital heart disease
  • Peripheral artery disease

According to the American Lung Association, cigarettes contain a staggering 600 ingredients. Many of which are harmful to human health. When these substances are burned, they generate more than 7,000 chemicals, including nicotine. At least 69 of these chemicals are known carcinogens, capable of causing cancer.3

Cigarette smoking causes more than 480,000 deaths in the United States each year. Tobacco use is the leading preventable cause of death worldwide.4  As of 2019, over 50 million U.S. adults (21% of the population) reported smoking a tobacco product. Of these, 34 million smoked cigarettes.5

Understanding how the chemicals in cigarette smoke impact human health can help people who smoke fully understand the risks. Smoking cessation programs and medications are available to help people transition from smokers to past smokers and improve their overall health.

The words cardiovascualr disease and a stethoscope

How Smoking Harms the Cardiovascular System

Smoking is one of the leading causes of cardiovascular disease. The thousands of chemicals in cigarette smoke and their metabolites can affect the cardiovascular system in multiple ways.6

Blood vessels

The chemicals found in cigarette smoke cause damage to the inner lining of blood vessels. The endothelium, or inner lining of blood vessels, regulates blood flow and blood vessel muscle tone and provides a smooth surface to decrease the risk of blood clots.

When the endothelium is damaged, plaque buildup occurs, and blood clots can more easily form. When blood clots dislodge, they can travel to the heart, lungs, and brain, causing a heart attack, pulmonary embolism, or stroke.

Plaque is fat, cholesterol, and other substances that form in the walls of blood vessels and make them stiffer and narrower. Increased plaque can cause decreased blood flow to vital tissue, such as the heart muscle, causing angina or heart attacks, or the brain, causing a stroke. Cigarette smoke contains acrolein, a toxic chemical that is easily absorbed into the bloodstream and may impact cholesterol metabolism and increase blood vessel inflammation.7

Nicotine, a chemical in cigarette smoke, causes blood vessels to constrict or narrow by stimulating the release of epinephrine and norepinephrine.8 Narrowing blood vessels decreases blood flow to tissue and causes peripheral arterial disease. It also increases heart rate and blood pressure, putting strain on the heart.

Substituting vaping or another form of smoking has not been shown to decrease the risk of cardiovascular disease. Research suggests that it is not the individual chemicals in cigarette smoke that are causing blood vessel damage but rather vagus nerve stimulation from airway irritation.9

Oxygen supply

Impaired lung function, increased carbon monoxide, and narrowed blood vessels can all contribute to decreased oxygen delivery to body cells.

Cigarette smoke contains carbon monoxide, a dangerous, odorless, and toxic gas that is absorbed into the bloodstream from the lungs. Carbon monoxide gas decreases the amount of oxygen carried in red blood cells by displacing oxygen molecules from hemoglobin, the protein that carries oxygen in red blood cells.

The chemicals in cigarette smoke can increase oxidative stress, which causes damage to red blood cells, further decreasing their ability to carry oxygen to body tissues.

Chemicals in cigarette smoke irritate the lining of blood vessel walls and lung tissue, decreasing oxygen transfer from the air in the lungs to the bloodstream and its delivery to body tissue.

Smoking increases your risk of high cholesterol and high blood pressure. If you are a smoker and are concerned about your health risks or want to learn more about your smoking cessation support options, contact one of the healthcare providers at Telegra MD. They offer 24-hour doctor care so that you get help when you need it. After evaluating your medical history, they will offer an online diagnosis and personalized suggestions for improving your health.

A woman taking a deep breath outside

Smoking and Heart Diseases

Since the chemicals in cigarette smoke can negatively affect blood vessel health and oxygen delivery, they can contribute to or worsen many forms of heart disease, including:

  • Congenital heart disease: low blood and oxygen delivery due to blood vessel damage, impaired lung function, and high blood pressure can all worsen a congenital change in the heart’s structure at birth.
  • Coronary heart disease: narrowed blood vessels and decreased blood delivery to the heart muscle can cause coronary heart disease. A condition that develops when heart muscle does not get the oxygen and nutrients it needs to survive.
  • Arrhythmias: decreased oxygen delivery and blood flow can cause heart tissue scarring, which increases your risk for arrhythmias or abnormal heart rhythms.
  • Angina and heart attacks: when the blood supply to the heart muscle is temporarily or permanently blocked due to a blood clot, it can cause angina (chest pain) or a heart attack.

According to 2020 Smoking Cessation: A Report of the Surgeon General, approximately 92 million U.S. adults have one or more types of cardiovascular disease. Since 1919, cardiovascular disease has accounted for more deaths than any other major cause of death.

In one study, over 95% of participants admitted they knew or believed smoking increased the risk of heart disease in smokers. However, about one-third continued to smoke even after a heart attack, heart failure, or stroke. After five years, one in five smokers continued to smoke.10

Relation of Secondhand Smoke to Heart Disease and Stroke

Secondhand smoke occurs when people around a smoker breathe in the harmful chemicals found in cigarette smoke. According to the Centers for Disease Control and Prevention, secondhand smoke causes nearly 34,000 nonsmokers to die from cardiovascular disease and 8,000 deaths from stroke each year.

Secondhand smoke increases your risk of heart disease and stroke by 20% to 30%, illustrating how important it is to protect nonsmokers from the risk of secondhand smoke.11

The thousands of chemicals in cigarette smoke cause endothelial damage, decreased oxygen delivery, increased blood clots, and high blood pressure, just as they do in smokers.

Psychological Effects of Smoking on Heart Health

In one study, over half of the 108 participants who were moderately or heavily dependent on nicotine also reported moderate-to-severe depression and 44% reported moderate-to-severe anxiety, as well. However, the degree of nicotine dependence was inversely related to the degree of depression and anxiety, which can make quitting more difficult.12

Smoking is arguably one of the strongest risk factors for cardiovascular disease. Psychological health is another important risk factor. Type A personalities, depression, and anxiety are associated with heart disease. It is unclear whether some smokers self-medicate their anxiety and depression with smoking. At least one study suggests an inverse relationship between nicotine dependence and anxiety and depression. This implies that smokers with anxiety and depression may need additional help with smoking cessation.12

A man holding an apple and examined by a doctor

Strategies to Prevent Heart Disease and Stroke

Reducing or even quitting smoking can significantly reduce your risk of cardiovascular disease. After one year of smoking cessation, the risk of coronary heart disease is cut in half and continues to decline. After 15 years of abstinence, coronary heart disease risk is comparable between smokers and nonsmokers.13

To reduce your risk of cardiovascular disease:

  • Talk to a doctor on call about your desire to stop smoking. Ask for an online prescription to support your smoking cessation plan.
  • Look for a smoking cessation support group.
  • Get regular physical activity. The CDC recommends a minimum of 150 minutes of moderate-intensity physical activity and two sessions of strength-building each week.
  • Consume a well-balanced, nutritious diet.
  • Evaluate heart health supplements and determine what works and what doesn’t.
  • Avoid smoking triggers.
  • Learn how to manage stress and anxiety without smoking.
  • Limit alcohol intake, as it may also increase cardiovascular disease risk and interfere with your resolve to stop smoking.
  • Get regular physical exams to monitor your current risk of cardiovascular disease and track your progress toward better health.
  • Avoid exposure to secondhand smoke.


While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.


1. Loretan CG, Cornelius ME, Jamal A, Cheng YJ, Homa DM. Cigarette Smoking Among U.S. Adults With Selected Chronic Diseases Associated With Smoking, 2010-2019. Prev Chronic Dis. 2022 Sep 29;19:E62. doi: 10.5888/pcd19.220086. PMID: 36173703; PMCID: PMC9541675.

2. National Center for Chronic Disease Prevention and Health Promotion (U.S.) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (G.A.): Centers for Disease Control and Prevention (U.S.); 2014. PMID: 24455788.

3. American Lung Association. What’s in a cigarette? Updated November 17, 2022. Accessed April 11, 2023.

4. Rigotti NA. Strategies to Help a Smoker Who Is Struggling to Quit. JAMA. 2012;308(15):1573–1580. doi:10.1001/jama.2012.13043

5. Cornelius ME, Wang TW, Jamal A, Loretan CG, Neff LJ. Tobacco Product Use Among Adults – United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Nov 20;69(46):1736-1742. doi: 10.15585/mmwr.mm6946a4. PMID: 33211681; PMCID: PMC7676638.

6. Moir D, Rickert WS, Levasseur G, Larose Y, Maertens R, White P, Desjardins S. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions.Chem Res Toxicol. 2008; 21:494–502. doi: 10.1021/tx700275p

7. Henning, R.J., Johnson, G.T., Coyle, J.P. et al. Acrolein Can Cause Cardiovascular Disease: A Review. Cardiovasc Toxicol 17, 227–236 (2017).

8. Tsai SY, Huang WH, Chan HL, Hwang LC. The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study. Tob Induc Dis. 2021 Oct 22;19:82. doi: 10.18332/tid/142664. PMID: 34720797; PMCID: PMC8534426.

9. Nabavizadeh, Pooneh & Liu, Jiangtao & Rao, Poonam & Ibrahim, Sharina & Han, Daniel & Derakhshandeh, Ronak & Qiu, Huiliang & Wang, Xiaoyin & Glantz, Stanton & Schick, Suzaynn & Springer, Matthew. (2022). Impairment of Endothelial Function by Cigarette Smoke Is Not Caused by a Specific Smoke Constituent, but by Vagal Input From the Airway. Arteriosclerosis, thrombosis, and vascular biology. 42. 1324-1332. 10.1161/ATVBAHA.122.318051.

10. Reynolds LM, Zamora C, Lee UJ, Stokes AC, Benjamin EJ, Bhatnagar A, Payne TJ, Rodriguez CJ. Tobacco Use Prevalence and Transitions From 2013 to 2018 Among Adults With a History of Cardiovascular Disease. J Am Heart Assoc. 2021 Jun 15;10(12):e021118. doi: 10.1161/JAHA.121.021118. Epub 2021 Jun 9. PMID: 34102851; PMCID: PMC8477862.

11. Office on Smoking and Health (U.S.). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (G.A.): Centers for Disease Control and Prevention (U.S.); 2006. Available from:

12. Papazisis A, Koreli A, Misouridou E. Heavy Smoking is Associated with Low Depression and Stress: a Smokers’ Paradox in Cardiovascular Disease? Mater Sociomed. 2019 Dec;31(4):268-272. doi: 10.5455/msm.2019.31.268-272. PMID: 32082091; PMCID: PMC7007605.

13. Puig-Cotado F, Tursan d’Espaignet E, St Claire S, Bianco E, Bhatti L, Schotte K et al. Tobacco and coronary heart disease: WHO tobacco knowledge summaries. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

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