Tobacco, Air Quality, and Heart Attacks

A COMING CATASTROPY:TOBACCO AND MYOCARDIAL INFARCTION


Kaye H. Kilburn, M.D.
University of Southern California, Keck School of Medicine

 

CHD-AMI [Coronary Heart Disease-Acute Myocardial Infarction] is the world’s most important disease, killing 6,300,000 people yearly, 3.5 million of these in developing countries (1,2).  [Editor’s note:  at the time of this abstract]  It was so rare in the previous century that it was considered an exotic variety of heart disease that stimulated speculation but no action.  Concern emerged in the first quarter of this century as more patients were diagnosed, it blossomed and caught-on.  The CHD-AMI plague emerged from obscurity to become epidemic by the 1950’s (3).  It was recognized first in America and in Britain, crept to Europe and engulfed the world.

 

From rare in 1990, the diagnosis became common by 1950.  Its upward trend coincided with those for cigarette smoking and burning hydrocarbon fuels in automobiles.  The causes of CHD-AMI appear elusive despite 50 years of intensive research.  Perhaps we need to think of it as a chemical contagion as the abrupt emergence of CHD-AMI in this century is poorly explained by its agreed upon risk factors.

 

The evidence that tobacco smoke causes CHD-AMI developed by 1958 and was strengthened when the deaths decreased in men and then women who quit smoking.  Evidence of parallel effect from air pollution from fossil fuel burning is deduced.  Worldwide bankruptcy and chaos from billions of deaths and massive numbers disabled can be avoided only by prevention of smoking.  A strategy is needed to stop cigarette production and tobacco growing. To do this simple job may take broader social action like that leading to the exclusion of asbestos from commerce.  It must be done as time is running out.

 

References:
Horton R: Future of European cardiology. Lancet 1999;354:791-792.
Fuster V: Epidemic of cardiovascular disease and stroke: the three main challenges. Circulation 1999;99:1132-1137.
Rosamond WD, et al.: Trends in incidence of myocardial infarction and mortality due to coronary artery disease 1987-1994. New Eng J Med 1998;339:380-385.
Henneken CH: Increasing burden of cardiovascular disease. Circulation 1998;97:1095-1102.

 

Reddy KS and Yusuf S: Emerging epidemic of cardiovascular disease in developing countries. Lancet 1998;351:586-590.