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Tobacco: totally avoidable risk factor of CVD

Smoking is estimated to cause nearly 10 per cent of cardiovascular disease (CVD) and is the second leading cause of CVD, after high blood pressure.1  The impact of tobacco smoke is not confined solely to smokers. Nearly 6 million people die from tobacco use or exposure to secondhand smoke, accounting for 6 per cent of female and 12 per cent of male deaths worldwide, every year. By 2030 tobacco-related deaths are projected to increase to more than 8 million deaths a year.1 Smoking is, however, avoidable and advancing a tobacco-free world is a key strategic priority for the World Heart Federation.

How tobacco causes cardiovascular disease

Tobacco acts in a number of ways to cause CVD. Its use, whether by smoking or chewing, damages blood vessels, temporarily raises blood pressure and lowers exercise tolerance. Moreover, tobacco decreases the amount of oxygen that the blood can carry and increases the tendency for blood to clot. Blood clots can form in arteries causing a range of heart diseases that ultimately result in a stroke or sudden death.

Facts and figures

  • Smoking causes one-tenth of CVD worldwide.1
  • Globally, tobacco causes some 6 million deaths a year.1
  • The risk for coronary heart disease is 25 per cent higher in female smokers than in male smokers.2
  • The risk of a non-fatal heart attack increases by 5.6 per cent for every cigarette smoked and persists even at only one to two cigarettes per day.3
  • Chewing tobacco more than doubles the risk of heart attack.4
  • Awareness of links between smoking and cardiovascular disease remains low in many parts of the world: in China, where the risk of stroke is very high, more than 70 per cent of all smokers do not know that smoking increases their risk of having a stroke.5
  • Smoking bans have been found to decrease the rates of heart attacks;6  the evidence indicates that smokefree laws are one of the most cost-effective ways to prevent heart attacks.7

Secondhand smoke exposure and its link to cardiovascular disease

  • There is no risk-free level of exposure to secondhand smoke.8
  • Non-smokers who breathe secondhand smoke have between a 25–30 per cent increase in the risk of developing a CVD.9
  • Each year, exposure to secondhand smoke kills 600,000 people: 28 per cent of them are children.8 Of all adult deaths caused by secondhand smoke, more than 80 per cent are from CVD.10
  • In China and Bangladesh, more than half of all adults working indoors are exposed to secondhand smoke and in Russia, India and Ukraine it is more than one quarter.11
  • In most countries surveyed around the world, the majority of smokers want to quit.11
  • In 2002, exposure to secondhand smoke was found to kill as many women in China as active smoking.12
  • Frequent exposure to tobacco smoke, whether in the workplace or home, has been found to nearly double the risk of having a heart attack.10
  • Exposure to secondhand smoke worldwide causes an estimated 603,000 deaths each year among non-smokers, including 379,000 deaths from ischaemic heart disease.10

Impact of quitting

  • Within 20 minutes of quitting smoking, blood pressure and pulse return to normal, and circulation improves.13
  • Within eight hours, blood oxygen levels increase and the chances of a heart attack start to fall.13
  • Within 24 hours, carbon monoxide is eliminated from the body and the lungs start to clear out mucus and debris.13
  • Within 72 hours, the lungs can hold more air and breathing becomes easier.13
  • Within five years, the risk of a heart attack falls to about half that of a smoker.13
  • Within 10 years, the risk of lung cancer falls to around half that of a smoker.14
  • Within 15 years, the risk of CVD becomes nearly the same as someone who has never smoked.15
  • Quitting when older is still worthwhile: among smokers who quit at age 66 years, men gained up to two years of life, and women gained up to 3.7 years.16


1Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization (in collaboration with the World Heart Federation and World Stroke Organization), Geneva 2011
2Huxley R, Woodward M. Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet. 2011;378(9799): 1297–1300.
3Vollset SE, Tverdal A, Gjessing HK. Smoking and deaths between 40 and 70 years of age in women and men. Ann Intern Med. 2006;144(6):381–389.
4Centers for Disease Control and Prevention (CDC), 2010. Smoking & tobacco use – Health effects of cigarette smoking. [Online]. Available at: [Accessed March 2012].
5International Tobacco Control Project. Cardiovascular harms from tobacco use and secondhand smoke: Global Gaps in Awareness and Implications for Action. World Heart Federation 2012.
6Institute of Medicine of the National Academies, 2009. Secondhand smoke exposure and cardiovascular effects: Making sense of the evidence. [Pdf]. Available at: [Accessed March 2012].
7Global Smokefree Partnership. Warning: Secondhand Smoke is Hazardous to Your Heart. 2010.
8World Health Organization, 2010. Fact sheet No. 339 – Tobacco. [Online]. Available at: [Accessed March 2012].
9U.S. Department of Health and Human Services , 2006. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
10Öberg M, et al, Global estimate of the burden of disease from second-hand smoke. Lancet. 2010; EPub.
11World Health organization Report on the Global tobacco epidemic, 2011, p 43.
12UCBerkeley News, 4 Sept 2005. Researchers find that passive smoking kills as many women as active smoking in China. [Online]. Available at: [Accessed March 2012].
13Irish Heart Foundation. Stopping Smoking. [Online]. Available at: [Accessed March 2012].
14National Health Service UK. Quit smoking to boost health. [Online]. Available at: [Accessed March 2012].
15Centers for Disease Control and Prevention (CDC). The 2004 Surgeon General’s Report. The Health Consequences of Smoking: What it means to you. [Pdf]. Available at: [Accessed March 2012].
16Taylor DH Jr, Hasselblad V, Henley SJ, Thun MJ, Sloan FA. Benefits of smoking cessation for longevity. Am J Public Health. 2002;92(6):990–996.