Substantial heart attack risk even smoking one a day

Just one cigarette a day carries nearly half the risk for heart attack and stroke as does smoking a full pack of 20, according to a large-scale study published yesterday.

“If someone smokes one cigarette instead of 20 per day, intuitively we’d think that the risk drops to 1/20, or 5 per cent,” said Allan Hackshaw, the lead author and a professor of cancer research at University College London, whose paper analysed 141 other studies.

“This seems to be the case for lung cancer but is not true for heart attacks and stroke, where one cigarette per day carries about 50 per cent of the risk of a pack a day,” he said.

Smokers should not be fooled, in other words, into thinking that a few cigarettes a day – or even just one – carries little or no long-term harm, he said.

“While it is great that smokers try to cut down – and they should be positively encouraged to do so – in order to get the big benefits on cardiovascular disease they need to quit completely,” he said.

The findings were published in the journal BMJ.

Tobacco kills about seven million people worldwide every year, according to the World Health Organisation.

About two million of those deaths are the result of cardiovascular disease, mainly coronary heart attacks and stroke.

Earlier research suggested that smoking a few cigarettes a day was linked to a higher-than-expected risk of heart disease, but findings were inconclusive.

Scientists led by Prof Hackshaw analysed the results of 141 studies, estimating the relative risk of one, five and 20 cigarettes a day.

They found that men who lit up once a day had 46 per cent of the excess risk of heart disease associated with smoking a full pack a day, much higher than expected. For strokes, the excess risk was 41 per cent.

For reasons that are not fully understood, the risk for women was smaller – 31 and 34 per cent, respectively.

“It could be a mixture of biological difference and differences in lifestyle,” Prof Hackshaw said.

Overall, long-term smoking shortens life expectancy by 12 to 15 years.

“This well-conducted study confirms what epidemiologists have suspected but few among the public have,” said University of Oxford professor Paul Aveyard, who was not involved in the research. “The implication is obvious – anyone who smokes should stop.”

At the same time, he said, it would be wrong to conclude that cutting down is useless.

“There is more reason to believe that lower cigarette consumption will reduce the risk of chronic lung disease and lung cancer, the other two big causes of early death from smoking,” he said.