The following are key points to remember from this perspective on the cardiovascular effects of exposure to cigarette smoke and electronic cigarettes:

1. Although there has been a significant reduction in the percentage of men and women who smoke, due to population growth, the absolute number of smokers has increased. Smoking exposes the smoker and those around them to more than 7,000 compounds, many of which are toxic. An estimated 6.3 million deaths occur annually due to primary and secondary cigarette smoke exposure.
2. Approximately one third of cigarette-related deaths are due to cardiovascular disease. There is a strong causal relationship between cigarette smoking and cardiovascular disease. Risk for cardiovascular disease occurs at all levels, even for those who smoke <5 cigarettes per day.
3. A meta-analysis of genome-wide association studies by the Tobacco and Genetic Consortium observed several common polymorphisms to be associated with smoking behavior including smoking intensity and smoking initiation. Additional studies have found genetic associations with increased risk of mortality and smoking. Epigenetic effects are also present, with DNA methylation associated with smoking.
4. Both primary smoking and second-hand smoke lead to endothelial dysfunction with increased oxidative stress, along with increases in macrophage and platelet activity. In addition, cigarette smoke is associated with a prothrombotic state with increased platelet reactivity and adhesiveness.
5. The clinical effects of smoking include increased risk for heart disease including myocardial infarction, sudden cardiac death, and heart failure. Smokers are at an elevated risk for peripheral arterial disease (PAD) including aortic aneurysm. Smoking is a risk factor for reinfarction, stent thrombosis, and complications after coronary artery bypass grafting and PAD interventions. Given the number of smokers worldwide, continued efforts to prevent initiation of smoking and to promote smoking cessation is of great public health importance.

Keywords: Aortic Aneurysm, Cardiovascular Diseases, Electronic Nicotine Delivery Systems, Heart Failure, Myocardial Infarction, Oxidative Stress, Primary Prevention, Peripheral Arterial Disease, Risk Factors, Smoking Cessation, Smoking, Thrombosis

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