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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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