Lorillard
the Health Consequences of Smoking Part 1 of 4
Fields
- Area
- LEGAL DEPT FILE ROOM
- Type
- PSCI, SCIENTIFIC PUBLICATION
- BIBL, BIBLIOGRAPHY
- CHAR, CHART/GRAPH
- BIBL, BIBLIOGRAPHY
- Alias
- 03765074/03765541
- Site
- N14
- Named Person
- Yamamota
- Amacher, R.H.
- Anderson, W.H.
- Anthonisen, N.R.
- Asnes, D.P.
- Auerbach, O.
- Avtandilov
- Ayers, S.M.
- Baker, C.
- Balazs
- Bargeron
- Bellet, S.
- Berkson, D.M.
- Best
- Bing, R.J.
- Blair
- Blesa
- Bock, F.G.
- Boren, H.
- Borhani, N.O.
- Boutwell, R.K.
- Bradess
- Bratic, E.
- Bunn
- Burn
- Carlysle, K.
- Cederlof
- Cook, D.G.
- Cooper, T.
- Cornfield, J.
- Dalhamn, T.
- Dayton
- Dement, M.E.
- Doll
- Doyle
- Dunn
- Earl, C.J.
- Epstein, F.H.
- Falk, H.L.
- Ferris, B.G., J.R.
- Fitzpatrick, M.J.
- Fletcher
- Frazier, T.M.
- Friberg
- Garfinkel
- Goldsmith, J.R.
- Greenspan
- Gsell
- Hammond
- Hanna, M.G., J.R.
- Hariyama
- Hecht, A.W.
- Higgins, Itt
- Hill
- Hoffmann, D.
- Holbrook, J.H.
- Horn, D.
- Hutchings, R.S.
- Irving
- Israel, R.A.
- James
- Jandl
- Jennings, J.M.
- Johnston, N.S.
- Kahn, H.A.
- Kannel
- Keller, A.Z.
- Keys
- Kien
- Kirsner, J.
- Kjeldsen
- Knox, D.L.
- Kolbye, A.C., J.R.
- Kotin, P.
- Krumholz, R.A.
- Leaders
- Leb
- Liebow, A.A.
- Lilienfeld, A.
- Long
- Macmahon, B.
- Mclean, R.
- Mcmillan, G.C.
- Mitchell, R.S.
- Murphy, E.A.
- Nadeau
- Paffenbarger, R.S., J.R.
- Paul
- Peterson, W.F.
- Peters, J.M.
- Petty, T.L.
- Plair
- Rand
- Rapaport
- Regan
- Reid
- Ritchie, M.H.
- Romero
- Rosenmann
- Ross
- Sackett
- Saffiotti, U.
- Saphir
- Schuman, L.M.
- Shapiro, S.
- Sherrod
- Shimkin, M.B.
- Shopland, D.R.
- Spain
- Stamler, J.
- Strobel
- Strong
- Talesnik
- Taylor
- Tibblin
- Travell
- Truett
- Underwood, P.B., J.R.
- Van Duuren, B.L.
- Victor, M.
- Viel
- Vonahn
- Watts
- Weir
- West
- Westfall
- White, R.W.
- Wilens
- Wing
- Wynder, E.
- Amacher, R.H.
- Recipient
- Steinfeld, J.L.
- Document File
- 03763512/03766002/S H Re 1979 Surgeon General S Report.
- Date Loaded
- 05 Jun 1998
- Named Organization
- Bureau of Foods
- Case Western Reserve
- Ca Inst of Technology
- Ca State Dept of Public Health
- Chicago Board of Health
- Chicago Peoples Gas
- Chicago Westen Electric
- Coke
- College of General Practitioners
- Council on Epidemology
- Danish Twin Registery
- Division of Vital Statistics
- East Orange Va Hospital
- FDA, Food and Drug Administration
- Harvard School of Public Health
- Health Insurance Plan of Ny
- Health Research Foundation
- Health Services Administration
- Hew, Dept of Health Education and Welfare
- Hri, Health Research Inst,Roswell Park
- Inter Society Commission for Heart
- John Hopkins School of Hygiene and
- John Hopkins Univ School of Medicin
- Kettering Medical Center
- Marquette School of Medicine
- Mayo Clinic
- Mcgill Univ
- Medical Center of Ny
- Medlars System
- Mental Health Administration
- Natl Air Pollution Control Administ
- Natl Center for Health Statistics
- Natl Center for Health
- Natl Clearinghouse for Smoking and
- Natl Heart Inst
- Natl Heart + Lung Inst
- Natl Hospital
- Natl Inst of Child Health + Human D
- Natl Library of Medicine
- Natl Research Council
- NCI, Natl Cancer Inst
- Niehs, Natl Inst of Environmental Health Sciences
- NIH, Natl Inst of Health
- Nj Va Hospital
- Ny Univ Medical Center
- Oak Ridge Natl Lab
- Peoples Gas Light
- Philadelphia General Hospital
- Public Health Service
- Regional Medical Program of Tx
- Sgc, Surgeon General's (Advisory) Comm
- St Vincent's Hospital and Medical C
- Twin Registries of Sweden
- Univ of Ca San Diego
- Univ of Chicago School of Medicine
- Univ of Co Medical Center
- Univ of Louisville School of Medici
- Univ of Mi
- Univ of Mi School of Public Health
- Univ of Mn School of Public Health
- Univ of Pittsburgh Graduate School
- Univ of SC Medical Scool
- Univ of Wi
- US Government Printing Office
- US Natl Academy of Sciences
- US Veteran Twin Registry
- Va Hospital
- Veterans Administration Central Off
- Veterans Follow-Up Agency
- Wa Hospital Center
- Webb Waring Inst for Medical Resear
- Western Collaborative Study Group
- Western Infirmary in Glascow
- Who, World Health Org
- Wood Va Hospital
- Ahf, American Health Foundation
- American Heart Assn
- Arteriosclerotic Disease Branch
- Bureau of Adult Health + Chronic Di
- Case Western Reserve
- Litigation
- Stmn/Produced
- Author (Organization)
- Health Services Administration
- Hew, Dept of Health Education and Welfare
- Mental Health Administration
- Public Health Service
- Hew, Dept of Health Education and Welfare
- Characteristic
- OVER, OVER SIZE DOCUMENT
- Master ID
- 03764103/6002
Related Documents:- 03764105
- 03764106
- 03764107-4109 Bibliography on Smoking and Health
- 03764110-4112 the Health Consequences of Smoking
- 03764129-4257 the Health Consequences of Smoking 750000 - Part 1 of 2
- 03764200-4257 the Health Consequences of Smoking 750000 - Part 2 of 2
- 03764260-4261 Statement by Horace R. Kornegay, President of Tobacco Institute, on the 740000 Health Consequences of Smoking, Hew Report to Congress Released 740628
- 03764266-4273
- 03764274-4551 the Health Conseguences of Smoking - Part 1 of 3
- 03764350-4451 the Health Consequences of Smoking - Part 2 of 3
- 03764452-4551 the Health Conseguences of Smoking - Part 3 of 3
- 03764552-4727 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 1 of 3
- 03764555
- 03764567-4666 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 2 of 3
- 03764667-4727 the Health Consequences of Smoking A Report of the Surgeon General: 720000 - Part 3 of 3
- 03764729
- 03764730-4735
- 03764736-4737
- 03764739-4740
- 03764747-4748
- 03764749-4961 The Health Consequences of Smoking A Public Health Service Review] 670000
- 03764962-5073 the Health Consequences of Smoking 690000 Supplement to the 670000 Public Health Service Review
- 03765309-5541 The Health Consequences of Smoking Part 3 of 4
- 03765543
- 03765545-5546
- 03765548
- 03765549 Informational Memo
- 03765550-5553 for Simultaneous Use with 710000 Surgeon General's Report on Smoking and Health
- 03765554-5556 Smoking Is Very Debonair
- 03765557
- 03765558-5965 Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 1 of 3
- 03765573-5726 Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 2 of 3
- 03765727-5965 Smoking and Health Report of the Advisory Committee to the Surgeon General of the Public Health Service - Part 3 of 3
- 03765966
- 03765967-6000 Report to Surgeon General's Advisory Committee on Smoking and Health - Materials on Cigarette Filtration
- 03766001-6002
- UCSF Legacy ID
- bmu51e00
Document Images
Contents
Page
iii':
ACKNOWLEDGMENTS .............................. v
Chapter 1. IlltrodUction .............................. ..1.
Chapter 2. Cardiovascular Diseases ...................... 15
Minter3'. ChronicObstructi~v~eBronchopulm,onaryDisease .................................. 135'
Chapter -i: Cancer ................................... 231
C'~;ai~tcr 5. Pregnancy ................................ 385
Chamer• Fil Peptic Ulcer .............................. 419.
Chaq)rer 7., Tobacco~ Amblyopia ........................ ~ ~ ~ 431
0
a.
iz
CHAPTER 1'
General Consideratibns;
Preparation of' tlhe Present Doowment„
and Summary of the Report
¢n
IL._ ~ ~o
%J
1
GENERAL CONSIDERATIONS
T': nia jor develbpment in the modern historyoftlhee#fectsaf ,rr,oK} ng on health occurred in 1950
with the publication of four
rr"r( •,r~~rt.ive studies on smoking, habits among lung cancer pa-
twn, -;:,nd among controls (I„ 4, G„7)., At that time,, the question.
":1rt, smokers more likely to get lung cancer thani nonsmok-
on; .1;rhough some epidemiologists were satisfied that the an-
.,~~ r r•t in the affirmative, others turned for confirmation to
inwhaeh t'hesmoking habits of' large popula-
t: :. r, - record'ed and the populations followed to identify sub-
~~,, The first report of Hammond and Horn in 1954t_~. si~,•nificantlyelevated overall death rates
for smokers,
to nonsmokers.. This elevation in death rates, almost
,.c-niined to those,whosmoked!cigarettes, together with~the:c- r-)r a ~;radient according to the
amount smoked, changed
~-ion f rornione concerning only liang, cancer to one concern-
r;ai (ieath rates and from one concerning smoking, to one.
coTacer:nedd with cigarette snaoking:In effect, the question
: r:.•. .'L)o cigarette smokers have higher overall death rates
,.,,n:.niokers and'smokers, of pipe& and cigars?;"
theimbliicationi of thel:at'er reports ofthe majiorprospec-:r. ;adie in the late 1950's and,early
1960's, it became clear that
cIWart•t,e. ;mokers had higher overall death rates than nonsmokers,
a-, v:ril as higher death rates from a number of individiZaI causes
of deuth..The question then becazne,"Why?,"«'hen the Advisory Committee on Smoking and Health to:
the
Surgeon General was established in 1962, it undertook the evalua-
tion of the scientific evidence up to that time. The:conclusion of the
Cc,ngmittee in its 1,9~6'4I Repbrt was that: "`Cigarettesrnoking, is a
health hazard of sufficient importance in, the United States to war-
rant appr opriateremedial action.'"" Not onlxdid theC~ommitteeconclud'e that the evidence clearly
showed that male cigarettee
smokers do in fact have higher death rates than nonsmokers butt
that the convergence of epidemiological, experimental, and path-
olUricad evidence also clearly imdicateda a cause-and-effect relation-
ship for several, of the implicated diseases,, particularly cancer of
tlhelung and, chronic bronchQtis,,, In several ot'herimportantdis-
eases, the evidence oni biornechanisrns to explain epidenlio]ogical
3
associations was felt to: be inadequate at that time to draw firm,
conclusions about a cause-and-effect relationship.
Three and one-half years later:,, when The Health Consequences
of Smoking : A Public Health Service Review, 1967' was publi'shed;,
the conclusions of'the 1964 review were taken as a starting, point,,
and the nature of the task of interpreting the scientific evidence
was& restated as follows :
1. How much mort'ality and excess disability are associated with
smoking?'
2. How much of this early mortality andl excess disability wouldl
not have occurred if people had not taken up~ cigarette smoking?'
3. How much of this early mortality: and excess disability couldd
be averted by the cessation or Vreduction of cigarette smoking,?'
4'. What are the biomechanisrns whereby these effects take place
andl what are the critical factors in these mechanisms?
That and subsequent reviews in 1968 and 1969 have provided
some answers to these questions, particularly in summariziing the
evidence for various theories as to how cigarette smoking affects
the human~ organism to: produce elevated disease and death rates..
At least five different processes have been suggested whereby:
cigaret!te smokers experience higher mortality or morbidity rates
than do nonsmokers,
1. Cigarette smoking initiates a disease process by producing
progressive irreversible damage. In this case, the total effect would
be approximately proportional to: the total accumulated' dosage
experienced over the years. Cessation of' smoking leaves impaire&
function which does not improve appreciably but does not continue
to deteriorate from continued exposure to cigarette smoke. How-
ever, such function may deteriorate through aging or through
exposure.to other harmfull agents. It appears that such a relation-
ship probably exists for chronic obstructive lung disease and posr
sibly for the development of atherosclerotic heart d7sease..
2. Cigarette smoking initiates a disease process with continual
repair and' recovery until some critical'! point is reached at which
the process is no longer reversible: The totall effect would therefore
be affected', to some extent by accumul'atedl exposure but would be
affected also by the level of' contemporary smoking. Cessation of
smoking, would result in a rapid reduction of risk provided the
critical levell ini'tiatimg, an irreversible process has not been
.
reached. The evidence supports this kind of mechanism accounting
both for the high d'ose-response relationshipl in lung cancer and for
the reduction in risk frorn lung cancer among ex-smok:ers:
3. Cigarette smoking promotes a disease process either by
provi:ding positive support to the development of a pathological
condition or by interfering witlh and diminishing the normal capa- .
4
0
bAl.,IN , ,:, rF-„ ~.,-tranism to cope with and defend against adiseasefi.,r ~~ "f i~ i1 maV take
place by promoting the development of a
~t;c1i ;~• ~+1 ,ii<e:rsetoaclinficaIlyrecognizable one, by promoting a,
;t:,te to a more severe form, or by increasing fatality
rat.* ;,•%-O,•+~ disease states. This type of mechanism could ae-
~s;a„~t~rrr+rle~tl, ~7 increased mortaIi~tyratesfora numberofse-
., r~ :+ + s i or which there is no evidence that cigarette srnoking,
r•++IEPin init'iating, the disease.S~ome of the ex~cessmor-
W. , :!i n i ectious respiratory disease and from coronary heart
take place through thi'& kind ofmechanssmf t r;c smoking produces a set of temporary conditions
,A i~:, rr+=,~ ~c the probability that acrit'ical event wil'loccurwith:o~. 6i.-~abili'ty and
possibly fatal consequences. For example,,
~ ir4ence to support the theory that each cigarette cani pro-
-t of condi'tionswhichincrease the probability of m~yocar-s., : ~vo through increased demand for
oxygen at a time when
is ,iiminished. Presumably,,once the supply/demand irmL
:..+... :+11(?t,.iated, the probability of myocardial damage would
normall level. Cessatian of' smoking should have an.
,~r,~'X+iiate effect of'reduci'ng the risk sharply for morbidity
produced through this mechanism.
r. cLe smoking, may be artificially related to excess dis-
icath b~~ way of a clbse association with some other con-
~' --s;)o,-;ure which is found at a high levell in smokers, but
ii:~ ni+ kers„and is itself responsible for the disease. The one
;, ,ieath for which cigarette smokers have elevated deathh
generally interpreted in this way is cirrhosis of the
:::cti mo;t heavy consumers of alcoholic beverages are smok-
+i:+i >iince aleohol consumption is an important part of' the
nat produces cirrhosis of the liver, the high rate of cirrho-
.,r7if4ias,rcigarettesmokersi~sdiscounted as,resulting, from thisni, ci ()f artificial relationship.
Some authors have proposed that
there may be genetic factors that link smoking andi certain diseases
in this fashion., Obviously, the cessat'iion, of'smokingwoul~dhave no
effect on morbidity or mortality from diseases which are artificially
related to smoking..
These different ways in which, cigarette smoking can be related
t'oie1e%,ated morbidity and mortality rates are important considera-
tions in attempting to estimate the potential public health benefits
of giving up smoking. Fbr some types of relationship, there would
haeno benefsts;for some,, rather small benefit'~s~~;for some,substan-
tial' benefits, taking piace over a long period of time; and for
others, substantial benefits taking place rather rapidly.
During the past few years, a sharp reduction has taken, place
in the cigarette smoking habits of the U.S'. population. The hTla-
5'
tional Center for Flealth~ Statistics has recently published a com-
parison of smoking habitls in the U.S. in 1955 and! 1966 based on
two large scale! household! surveys! (5). These! showed a drop, in,
cigarette consumption in men under 55 years of'age but no appre-
ciable change among those 55 or over. Among women, every age
group showed an increase in the eleven year period. A recent sur-
vey conducted for the National Clearinghouse forS'moking and~
Health, based on, a much smaller sample (approximately 5,000
intlerviews), was conduetied' in the Spring of 1970 (3) (itable 1).
Eveni with the smaller number of cases„ it is clear that a much
larger drop took place in the four years from 1966, to 1970 than
in the eleven years fromi 1955 to 196'6. The drop extendedl to the
age group 55-64 among men, again with no appreciable d'rop
among men over age 6'5'. For the first time, the increase in, smok-
ing among women leveled off,, or even dropped slightly among
women under 55. The increase among women over 551 was of a
lesser magnitude than previously observed.
TABLE 1. Percentage of Current Smokers of' Cigarettes (regu-
larly or oc~casional'ly)! by sex and age. U.S., Surveys: 1955axtd.
196B (CPS-Current' Polrutation Surueys) and 1970 (1VCSH-
Surveyconducted for National Clearinghouse for Smoking &
Healtli).'
Male Female.
A'Se. CPS
1955~~ CPS
196I6~ NCSH
1~970~. CPS
1955~ CPS'
~1966~ NCSH
1970
18-24 ---------- 53.0 48;3 2 47.0 33.3' 34.7 '31,1
25-34 ---------- 63.6 58.91 46.8' 39.2 43.2 40.3
35-44 ---------- 62.1 57.01 48.6' 35.4 41.1 39.01
45-54 ---------- 58.0 53.1 43.1 25171 37.3 36,0
55-64 ---------- 45.8 46.2 37.4 13A 23.0 24'.3
65 - ---------- 25.8 24.6 23!7 4':7 8.11 11.8
'1955' surveyy basedd onn approximately45;000 persons; 1966 survey,basedl onapproximately.
35,0000 persons; 1970 survey basedd onn approximately 5~000 persons.
" Fist imated.
With the massive changes in smoking behavior which have
taken place among adults in the past few years, largely as an
expression, of the desire to protect health, changes should be ex-
pected in mortality rates among those groups which have experi-
enced the greatest reduction bothiln accumulated dosage: and in
concurrent dosage. An analysis of U.S: mortality rates for 1970
and the years to follow will provide a, very valuable addition to the
knowledge concerning the effects of smoking on death rates.
PREPARATION OF THK PRESENT' DOCUMENT
Following the publication of Smoking and Health-Report of
the Advisory Committee to the Surgeon, General--.iln 1964, the fol-
6
ents were published as reviews of'the medical litera-
•,r., r, nin~* the health consequences of'smoking, as called for
Lai«-89-9!2:
1. 1T,_allth Consequences of Smoking, A Public Health Serv-
1.e~-iew: 19671.
Flealth Consequences of Sinoking; 1968' Supplernent to
;., 1967 PHS R'eview..
ll alth Consequences of Smoking, 1969 Supplement to
11,67 PHS Review.
-,, ti-)cumentsr.eviewed themedicallitleraturee which had
=,'idished since the original Surgeon General's Report. This
ot' publhshing a supplement to a supplement has become
irtrticularly ini the light of the lackof availability of the
rovie«•.s to the general! public: Therefore, when Public
.. ...;-'°2''was signed i'ntolawon Apri~l1, 1970 calling, , for an:, ":(,ilth interval between the
last report andl the new re-
; ~ itci'sion was madeto~ review the entirefieldl with em-
; u,e most recent additions to the literature..
~,.~innad Clearinghouse forSmokin'g and Healthi ha& the
1 , ,i;iit% - forcontinuousrnonitoringandr cornpilati~on of the
rarure on the health consequences of' smoking: This is
through several mechanisrns:
+<t:~ntifac r~eviewcorporation is on contracttoext'ract amti-
:nukintr and health frorni the medical, and scientific litera-
:a World. This organieationi provides a semi-weekliy acces-
ith abstracts and copies of the various articles. Trans-
:ffe: oalled for as needed. A;rticles of pertinence are identi-
;%. :t .,~eries of code words and phrases,
\iitional Library of Medicine; through the Medlars sys-
the Nationali Clearinghouse for Sinokiing and Healthi a
r'. r: i;lY li:;ting, of articles in the smoking and health area. These.
"re iv\ric«-ed,andpertiinentarticles aa•eord'ered•. Staff members keep, up with the current
contents of inedical
;cierltific literatur•eand identify articles of pertinence.
Ihi~i'tialdraft's,of'the present reviiewwereprepared by Clearing-
house stafff and consultants who reviiewed the previous report's and
i'ripntifi'ed those articles which have been important in, the develop-
nw>>t of knowledge ini this fie1dL These were abstractedl and' placed.
into tabularr form, andl a draft text of the report was prepared.
1•he tirs ', drafts of' the individual chapters were sent to experts
for review;, criticism, andl comment with respect to the articles re-
viewed,, those articles not included, andl conclusions. The drafts
were then revisedi on the basis of these comments and rewritten,
until' they met with general approval of the reviewers. The final'.
7
I ~%
.
d'rafts were reviewed' as a whole by the Directlor of the Nationall
Clearinghouse for Smokingandl Health, the: D!irectoroftheNar tional Cancer Institute, the Director
of the National Heart and
Lung, Institute, the Director of the National Institute of Environ-
mental Health Sciences, and by six additional experts both within
and outside of the Public Health Service.
SUMMARY OF THE REPORT
CARDIOVASCULAR DISEA'SES
Coronary Heart Disease
1. Data frorn numerous prospective and retrospective studies
confirm the judgment that cigarette smoking is a significant risk
factor contributing tlo the development of coronary heart disease,
including fatal CHD and its most severe expression, sudden an&
unexpectedi death. The risk of CHD incurred by smoking of pipes
and cigars is appreciably less tliani that incurred' by cigarette
smokers.
2. Analysis of' other factors associated' with CHD1 (highi serum
cholesterol, high biood' pressure, and physical inactivity) show
that cigarette smoking operates independently of these other fac-
tors andl can act jointly with certaini of them to increase the risk
of CHD appreciably.
3. There is evidence that cigarette smoking may accelerate the
patliophys'iol'ogical changes of pre-existing coronary heart disease
and' therefore contributes to sudden death from CHD.
4. Autopsy studies suggest that cigarette smoking is associated
withi a, significant increase in atherosclerosis of the aorta andl
coronary arteries.
5. The cessation of smoking is associated with the decreasedl
risk of' d'eathi from CHiD.
6. Experimental' studies in animals and humans suggest that
cigarette smoking may contribute to the deveiopment of'CHiD and/
or, its manifestations by one or more of the following rnechaniisms :
a~ Cigarette smoking, by contributing: toi the release of catecho-
lhmines, causes, increasedi myocardial wall tensilon„contractionvel'ocity; and heart rate,
and'thereby increases the work of the
heart andl the myocardial demand for oxygen and other
nutrients.
b:Amongilndividualswith coronary atherosclerosis, cigarette!
smoking appears to create an iinbalance between the increased
needs of the myocardiumi andl ani insufficient increase in cor-
onary blood& flow andl oxy genation.
c. Carboxyhemoglobin, formed from the inhaled carbon mon-
a.
P
linishes the availability of oxygenito the myocardium
;,,l.;o contribute tolthe development of atherosclerosis.
~, •1,ilirmc~~nt of pulmonary function caused by cigarette
ma s contribute to arterial hypoxemia, thus reduicing
~-:1,1,nn~t of ox~~y~gen, available t~o~~the~myocardi,um~o r!I- ~~iuoking may cause an increase in
platellet adhesive-
.
.,1rirh might contribute tolacute thrombus formatiom
~';~tratr»ient' of'R~ecent A~ddi.tions~ toKnoivl'edg,e Relati'rzg~
~,>>(l C'orona7y Heart Disease.-A number~ of~~ epidemi-
ti~~;have~ prov~idledl additional evid'enc eence conc~erni~ng~ciga~-
r. as a significant risk factor in the development of
perimental studies on animals have suggested that ciga-
king, particularly the absorbed nicotine and carbon mon=
',ntril,utes to the development of' atherosclerosis.
~rr>:clilar Disease~
: i-r,m numerous prospective studies indicate that ciga-
::i, ,, iy associated with increased mortalit'y, from cere-
(6,ease.
-iniental evidence concerning~ the relationship of srnok-~
~; ck,•,1ei,rovascul~ar disease is, at~ present insu~Pficient to: a11bw~
concerning, pathogenesis., However, some of th~e~
~~ --,gical cons~~it3erations~ discu~ssed' concern2ng, CHiD~ may~
t r.:,in to the relationship of smoking and CVD, particularUy
.. inriarctian.~
t'ic Aortic Aneurysm
smoking has been observed to increase the risk of
~:n>>onsyphilit'iic aortic aneurysm.
, ~lib,,~ rad Vascular Disease.
1'. llnta, from ai number of retrospective studies have indicated
tl,at cigarette smoking is a likely risk factor in the development
of E eripherall vascular disease. Cigarette smoking also appears to
be al factor in the aggravation of peripher.all vascular disease.
2. Cigarette smoking has been observed to alter peripheral blood
iiuw and peripheral vascular resistance.
CHRONIC OBSTRUCTIVE BRONCHOPULMONARY DISEASE
1. Cigarette smoking is the most important cause of chronic
obstructi~~~e bronchopulmonary disease im the United States. Ciga-
rette smoking increases tlhe risk of d~ing fromi pulmonary ernphy-
senra and chronic bronchitis. Cigarette smokers show an increased
prevalence of respiratory symptoms, including coughy sputum pro-
9
.4.~;.-r
"'Nv:,.177"
4'
WL ,.9s-..:
