The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
SMOKING
CESSATION & RISK
OF DEATH
Smoking,
as we all know, is associated with an increased risk of cancer,
cardiovascular
disease, non-cancer lung disease, and early death.
It is also widely known that smoking cessation
will, over time, lead to a reduction in smoking-associated health risks. However, the extent of
this reduction, and
the duration of smoking cessation required to realize significant
health
benefits, has not been entirely clear.
Now, a new clinical research study from the Washington
University School
of Medicine and Harvard University, and published in the Journal
of the American Medical Association, provides important data
that directly addresses these critical questions.
This study was part of a much larger overall
study, the Nurses’ Health Study, and includes more than 100,000 female
nurses
who have participated in this prospective clinical research trial since
1980.
In
this particular clinical study, a total of 12,483 women died during the
course
of the parent study. Among
the women who
died, 36% were “never-smokers,” 29% were active smokers, and 35% were
prior
smokers who had previously quit. When
all 104,519 women participating in this huge study were evaluated,
active
smokers were found to be almost 3 times more likely to die (of any
cause) than
“never-smokers.” When
the researchers
looked at the incidence of cancers known to be associated with smoking,
the
active smokers had more than 7 times the risk of these cancers than
were
observed among the women who have never smoked.
Even those cancers not definitively associated with
smoking were still more
commonly observed among the active smokers, occurring approximately 1.6
times
more frequently in this group when compared to the “never-smokers.” When compared to
“never-smokers,” the
incidence of colon and rectal cancer was observed 1.6 times more
frequently
among the women who were active smokers, and 1.2 times more often among
the
women who had smoked in the past but previously quit.
Death due to lung disease (other than cancer)
was (not surprisingly) also significantly more common among the women
who were
active smokers.
Based
upon the results of this long-term prospective study, a full 20 years
of
smoking cessation was necessary before death rates in previous smokers
fell to
the level observed among “never-smokers.”
Strikingly, when the actual causes of death were assessed,
this study
concluded that 64% of the deaths observed among the actively smoking
women were
directly attributable to cigarette smoking, while 28% of the deaths
observed
among the former smokers were smoking-related.
This
study is very valuable from a public health perspective, as it relies
upon a
very well designed and managed prospective clinical research trial,
with
long-term follow-up, to provide high quality clinical data. In doing so, the
statistics derived from this
study are both sobering and likely to be valid.
What is abundantly clear is that smoking is a potent cause
of otherwise
preventable and early deaths. What
is
also clear is that the earlier one starts smoking, and the longer one
continues
to smoke, the greater the risk of chronic illnesses and early death. On the other hand,
quitting smoking can, over
time, reduce the excess risk of illness and death associated with
smoking. This risk
reduction begins immediately after
smoking cessation, but it appears to take approximately 20 years before
all of
these smoking-related health risks disappear entirely.
The lesson is simple, really.
You are much better off, health-wise, if you
never start smoking. However
if you are
already a smoker, quitting (and quitting right now) will allow you to
begin
that long but worthwhile journey back to the level of health risk that
you
would otherwise have enjoyed had you never started smoking in the first
place.
CHILDHOOD
TRAUMAS &
ADULT SUICIDE RISK
The
experiences
that we have during the pivotal developmental years of our childhood
can have
an enormous impact on our adult lives.
Many among us struggle, consciously or subconsciously,
late into life
with the adverse experiences of our early years.
A new clinical study from the University of
California at San Diego, and from several medical centers in Canada,
and just
published in the American Journal of
Public Health, further illuminates this very private arena of
our lives, and
the results of this study are rather sobering.
Using data from a large mental health study, sponsored by
the National
Institutes of Health, in which nearly 10,000 adult men and women
volunteered to
take a detailed survey within their homes, this particular research
study was
designed to assess the impact of childhood traumas on mental health and
suicide
risk during adulthood. The
specific
types of adverse childhood experiences assessed included physical
abuse, sexual
abuse, and the witnessing of domestic abuse.
Based
upon the
data collected during this study, the researchers estimated that 22% to
32% of
the psychiatric disorders observed in the women volunteers were
associated with
adverse childhood events, while 20% to 24% of the mental illness
observed in
the male volunteers appeared to be associated with traumatic childhood
experiences. Suicidal
thoughts and
actual suicidal attempts in women appeared to be linked to adverse
childhood
events in 16% and 50% of such cases, respectively, and in 21% and 33%
of men,
respectively. Increasing
numbers of
traumatic events experienced during childhood also appeared to be
associated
with an increasing risk of psychiatric illnesses and thoughts of
suicide (or
actual suicidal attempts).
While
mental
health studies, such as this one, rely on far more subjective findings
than
most non-psychiatric clinical research studies, the results of this
study
nonetheless provide at least a semi-quantitative estimate of the
contribution
of traumatic childhood illnesses to those people already suffering from
mental
illness, including those who have either contemplated or actually
attempted
suicide. While
there are many among us
who have suffered tremendously adverse experiences during childhood,
and who
nonetheless have progressed into adulthood without any obvious evidence
of any
mental health difficulties, clearly, there many people who continue to
struggle
with the impact of such early-life experiences throughout their adult
lives. If you are
one of those people
who struggle with depression, poor self-esteem, chronic anxiety, or
other
troubling symptoms of poor mental or emotional health, then I urge you
to seek
help from your personal physician, or from a mental health professional. The same goes for the
thousands of young men
and women who are returning from the battlefields of Iraq
and Afghanistan
with post-traumatic stress disorder symptoms.
If you are feeling badly, please get help, now.
“WHITE
COAT” HYPERTENSION & CARDIOVASCULAR
DISEASE RISK
Most
physicians are very
familiar with the “White Coat Syndrome.”
Patients who are anxious about their visits with their
doctor often have
evidence of increased adrenaline secretion, which typically manifests
as anxiety,
sweating, a rapid pulse, and elevated blood pressure.
In most cases, after the patient has become
more comfortable with their physician, these signs of an overactive
sympathetic
nervous system begin to subside. I
often
see this “syndrome,” particularly in patients seeing me for the first
time, or
in those who have returned to see me for results of biopsies and other
surgeries. Since I
am exclusively a
cancer physician and surgeon, the stakes for most of the patients who I
see are
very high, and many of them are, understandably, very anxious about
both the
reasons for their visit with me and the potential outcomes of their
visit. I, and many
other physicians, have also noted
that patients with minimal or very mild baseline hypertension often
experience
significant “White Coat Syndrome,” particularly with respect to their
blood
pressure readings at the beginning of their visits with us.
A
newly published clinical
study, in the European Journal of
Internal Medicine, looks more closely at the relationship
between “White
Coat Syndrome” and the presence or absence of cardiovascular disease. In this study, 100
patients already suspected
of having coronary artery disease (but never diagnosed) underwent blood
pressure measurements, for 24 hours, in an ambulatory clinic, and then
underwent ultrasound evaluation of their hearts and carotid arteries
(the large
arteries in the neck the supply the majority of the blood flow to the
brain). Additionally,
these patients
also underwent coronary artery angiograms to further assess their
coronary
arteries.
This
study determined that
the patients who presented with “White Coat Syndrome” in the ambulatory
clinic
were significantly more likely to have coronary artery disease than
those
patients who, despite already being suspected of having coronary artery
disease, presented with normal blood pressure measurements. Likewise, in the group of
patients who
initially presented with elevated blood pressure readings, the
incidence of abnormal
heart function and narrowed carotid arteries (from atherosclerosis) was
significantly greater than was observed in the patients who did not
initially
present with high blood pressure readings.
In
summary, among 100
patients suspected of having coronary artery disease, those who
presented
initially with elevated blood pressure readings were much more likely
to have
significant coronary artery disease, abnormal heart function, and
narrowed
carotid arteries than those patients who presented, initially, with
normal
blood pressure readings. Based
upon the
results of this study, the presence of “White Coat Syndrome” may, at
least in
some patients, be a harbinger of underlying cardiovascular disease, in
addition
to being a manifestation of patient anxiety during their visit with
their
doctor.
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
