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Using Addictive Substances
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Nothing Light About 'Light' Cigarettes
A report recently issued by the National Cancer Institute proves what
many people have suspected all along: "light" cigarettes are
more a marketing ploy, than an attempt to make smoking safer.
Light and ultralight cigarettes produce lower amounts of tar and nicotine
than regular cigarettes when smoked by testing machines. However, this
is not the case when a person uses them. This is due to the smoker's
desire to get as much of the harmful chemicals as possible, and from
the design of the cigarette. Because smokers are addicted to nicotine,
not the act of smoking, they usually inhale harder on light cigarettes
or simply smoke more of them to get their fix. And the way the cigarettes
are designed- with ventilation holes placed where smokers' fingers or
lips easily block them - means smokers are often inhaling harder than
necessary, regardless of whether or not they are craving more nicotine.
In the 1960s and '70s, studies on light cigarettes showed promising results.
Smokers using the reduced strength cigarettes had lower risk of lung
cancer risk than those using the full-strength tobacco products. The
increasing use of light products was expected to further decrease smoking-related
diseases. Unfortunately, this has not come to pass. Lung cancer rates
rose until the early 90s. And it was a decrease in smoking in general—not
tobacco light—that has caused the decline seen since then.
December 2001 Update
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Smoking Cessation and Congestive Heart
Failure
Quitting smoking greatly reduces your risk of death from congestive
heart failure within two years.
Despite a lack of evidence, physicians have long advised patients with
congestive heart failure to quit smoking to improve their chances of
survival. Now, a recent study provides the necessary proof.
Researchers in Canada investigated the rates of death, hospitalization
for heart failure, and heart attack in smokers, ex-smokers of less than
2 years, ex-smokers of more than 2 years, and non-smokers. All the participants
in the study had congestive heart failure in the form of left ventricular
dysfunction — failure of the left ventricle of the heart to properly
pump oxygen-rich blood to the body.
The study found current smoking was associated with a substantial increase
in the risk of death, rate of hospitalization, and heart attack. Patients
who had quit smoking or never smoked had a 30% lower risk of dying during
the time of the study (41 months). Moreover, ex-smokers had the same
mortality rate as non-smokers.
These results suggest people who quit smoking lower their risk of recurrent
congestive heart failure within two years. The research also showed the
benefit from quitting smoking was just as great as the benefit from taking
drugs for heart failure.
September 2001 Update
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More Encouraging Data on
Alcohol and the Heart
Having a drink or two per day lowers your risk heart disease
and stroke. Little surprise then that two new studies report people who
drink alcohol also have lower risk of developing heart failure and better
outcomes if they have heart attacks. The studies were reported in a recent
issue of the Journal of the American Medical Association.
The first study involved 1913 adults who were admitted to 45 different
U.S. hospitals between August 1989 and September 1994 for heart attacks.
The researchers, who were based at Harvard Medical School and Harvard
School of Public Health, interviewed the patients an average of 4 days
after their heart attacks, inquiring about a range of issues including
their alcohol consumption.
About half (47%) reported they didn't drink alcohol during the year before
their heart attacks. Another 36% said they drank fewer than 7 drinks
per week. The remainder (17%) said they had 7 or more drinks per week.
Those who drank the most were younger, and more likely to be male, current
or former cigarette smokers, and have physically active life styles.
Survival rates were lowest for those who did not drink at all before
their heart attacks and best for those who drank 7 or more drinks per
week. For every 100 people, 6.3 of the abstainers died each year, compared
with 3.4 of those who drink 1-6 drinks per week and 2.4 of those drank
7 or more drinks.
Heart failure
The second study was based on 2,235 elderly people (average
age 74 years) who participated in a long-term epidemiological survey
in New Haven, CT. None of the subjects had heart failure at the time
of enrollment in the study in 1982. And the researchers excluded heavy
drinkers (those drinking more than four drinks per day).
Half of the subjects reported no alcohol consumption in the month before
enrollment, while 40% reported consumption of 1-20 ounces (up to 1 or
1.5 drinks per day), and 10% reported drinking 21 to 70 ounces (about
1.5 to 4 drinks per day).
During the next 14 years, 281 people developed heart failure, including
28 fatalities. The rates of heart failure for every 1000 people per year
were 16.1 for abstainers; 12.2 for those who drank 1-1.5 drinks per day;
and 9.2 for those who drank more heavily. Statistical analyses that adjusted
for other differences among these groups concluded that light drinking
reduced one's risk for heart failure by 19%, and moderate or heavy drinking
reduced the risk by 53%.
Because moderate drinking can easily progress to problem drinking, no
experts feel comfortable in encouraging nondrinkers to take up alcohol
for medical reasons. However, researchers are debating whether some people
who have given up alcohol might be encouraged to resume it. Future research
may also define certain subgroups who can benefit most from alcohol,
perhaps by raising their HDL cholesterol.
September 2001 Update
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Lung Volume Reduction Surgery
Poses High Risk for Certain Patients
Patient eligibility for lung volume reduction surgery (LVRS),
a procedure for treating emphysema, has been modified because of early
findings from the National Emphysema Treatment Trial (NETT).
NETT, a five-year randomized study, is comparing the safety and effectiveness
of LVRS with medical treatments, such as medications and exercise rehabilitation,
in patients with advanced emphysema. The study has already found emphysema
patients who have severe lung obstruction with either limited ability
to exchange gas when breathing or damage that's evenly distributed throughout
their lungs receive little benefit, and are at an unacceptable high risk
of death from the surgery.
LRVS is believed by some to improve the ability to move air in and out
of the lungs by surgically removing up to 30 percent of the diseased
lung — targeting the most damaged regions — with the expectation
the remaining lung will have better air exchange. However, high-risk
patients who survived the surgery were found to have only slightly improved
functional outcomes and quality-of-life scores six months later.
As a result, NETT is no longer enrolling patients who have a forced expiratory
volume (FEV) in one second that's less than 20 percent of their predicted
value, plus one of the following characteristics: severe loss of lung
surface area or homogeneous (evenly distributed) damage to the lung caused
by the disease.
September 2001 Update
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Insomnia and Alcohol Dependence: A Dangerous Duo?
An alcoholic's sleep patterns prior to attempted recovery may indicate
the risk of relapse, according to a study recently published in the American
Journal of Psychiatry.
The study, conducted at the University of Michigan Medical School, suggests
that alcoholics who experience insomnia prior to abstinence are more
likely to relapse than alcoholics without chronic sleep problems. Although
not conclusive, the study found insomnia was "significantly associated" with
the severity of alcohol dependency and depression in the patients observed.
All told, 172 patients, who averaged 32 days of abstinence, were observed
and 74 of them were followed up for an average of five months. Thirty
percent of patients followed who did not have insomnia relapsed. The
percentage for patients with insomnia was twice that, but remarkably
a history of self-medicating with alcohol to relieve insomnia didn't
appear to figure into the relapse rate.
A qualifying factor is that most patients who were studied upon entering
treatment reported having previous symptoms of insomnia. Moreover, health
professionals generally accept that poor sleep — not necessarily
clinical insomnia — can go hand in hand with alcoholism, and may
intensify during withdrawal. But patients in the study screened for the
symptoms that qualify them as insomniacs before treatment remained at
greater risk for relapse.
A significant problem addressed by the study was the penchant of recovering
alcoholics to use alcohol as a sedative, enabling them to sleep. This
strategy is self-defeating. It may work at first, but as tolerance to
alcohol builds, so does its ability to impair sleep, and dependence grows.
August 2001 Update
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Low Cholesterol Doesn't Make
Smoking Safer
The incidence and toll of heart disease is increasing throughout
the world, including in places you might not expect. For example, in
the 1990s atherosclerotic heart disease became the leading cause of death
in the Republic of Korea (South Korea). This may seem surprising because
in East Asia, people tend to be leaner and have lower blood cholesterol
levels. But in these countries, another potent risk factor for heart
disease, cigarette smoking, is rampant. Seventy-two percent of Korean
men, 50% of Chinese men, and 58% of Japanese men smoke.
In a recent study, researchers analyzed the interaction
among heart disease risk factors in 106,675 Korean men who underwent
insurance evaluations between 1990 and 1992. Most of these men (58%)
were current cigarette smokers, and 60% had "healthy" total
cholesterol levels below 200 mg/dL. During a six-year follow-up period,
3% of the men were either admitted to the hospital for a cardiovascular
problem or died of heart disease. When compared to men who never smoked
cigarettes, current and former smokers were roughly 1.5 times more likely
to suffer from atherosclerotic cardiovascular disease — even those
smokers with the lowest cholesterol level (below 171 mg/dL) were at greatly
increased risk.
Clearly, the message is that smoking is a significant and
dangerous factor for heart disease. But the logical extension is that
a good cholesterol level doesn't cancel out the effects of other heart
disease risk factors, smoking included.
For more information on the dangers of smoking see page
58 of the Family Health Guide.
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New Drug May Better Help Prevent Alcoholism
Relapse
Opiate antagonists are drugs that can decrease the pleasurable effects
of drinking alcohol and therefore can be useful for people trying to
quit drinking, particularly during the first few months. Naltrexone (ReVia)
is an opiate antagonist that has been shown to be effective in preventing
drinking relapses but can cause intolerable nausea in some people. In
addition, this drug may damage the liver as the dose is increased. This
limits its usefulness because liver disease and a history of heavy drinking
often go hand-in-hand.
A newer opiate antagonist, nalmefene, may offer a promising alternative.
A recent study showed that over a 12-week treatment period, patients
taking nalmefene were almost two-and-one-half times less likely to relapse
compared with those taking a placebo. Also, there was no evidence
that this medication caused liver problems or other serious side effects.
While some patients taking nalmefene experienced nausea, none skipped
their doses or stopped treatment for this reason. Nalmefene may become
a good first-choice drug to help treat alcohol dependence.
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Tobacco Smoke Can Trigger Childhood Asthma
A new study further highlights the need to eliminate children's exposure
to tobacco smoke. After evaluating a random sampling of about 40,000
children between the ages 6 and 7 and 13 and 14, researchers in Italy
determined exposure to the secondhand smoke of at least one parent increased
a child's relative risk of asthma.
The children's parents were surveyed about their smoking habits and
the respiratory health of their children. Children in both age groups
who were exposed to secondhand smoke from both parents were more likely
to have asthma. Having a mother who smokes was a slightly stronger predictor
than having a father who smokes.
These results bolster previous research that has linked exposure to secondhand
smoke in the home to childhood asthma. Restricting smoking to outside
the home doesn't seem to help either. A 1997 study in California found
that even if their parents smoked outside, children hospitalized for
acute asthma took longer to recover when discharged than children whose
parents did not smoke. Tobacco smoke clings to hair and clothes fibers,
so even if the activity itself takes place away from child, the child
can still be exposed to secondhand smoke.
For more information about asthma, see page 505 of the Family Health
Guide. For tips on how to quit smoking, see page 57.
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Study Links Smoking to Colorectal
Cancer
Lung, mouth, and bladder cancers, among others, are well
established as cancers caused by cigarette smoking. A recent study from
the American Cancer Society, published in the Journal of the National
Cancer Institute shows that cigarette smoking also raises the risk
of dying from colorectal cancer, which is cancer of the colon or rectum.
Indeed, the study notes that as many as 12% of colorectal cancer deaths
in the United States may be associated with smoking.
Researchers analyzed data from 312,332 men and 469,019 women enrolled
in the Cancer Prevention Study II. They found that for both men and women,
risk of colorectal cancer increased after 20 or more years of smoking.
Among men, current smokers were 31% more likely to die from colorectal
cancer than nonsmokers; female smokers were 41% more likely than nonsmokers
to die from the disease. The risk of death from colorectal cancer rose
with the number of years cigarettes were smoked, the number of cigarettes
smoked per day, and the number of packs smoked over the years. In addition,
the risk of death was higher the younger a person was when he or she
started smoking. The association was not confined to cigarette smoke.
Those who smoked pipes or cigars also faced a significantly increased
risk of death from colorectal cancer.
The bright spot of the study was that it showed a benefit from quitting.
Twenty years after quitting, men's risk of colorectal cancer death returned
to normal. And women who had stopped smoking 10 or more years earlier
had the same risk as nonsmokers. The take-home message: If you smoke,
stop. If you don't smoke, don't start.
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