Although most Americans associate smoking with lung cancer, cardiovascular diseases are also a significant risk. About one in 5 deaths from heart attacks and strokes are attributable to smoking, according to the American Heart Association. An estimated 37

Researchers have identified several ways in which smoking harms the cardiovascular system. Smoking decreases the proportion of high-density lipoproteins (HDL or "good") cholesterol to low-density (LDL or "bad") cholesterol, which leads eventually to an increasing accumulation of plaque in the vessels. Smoking also increases the tendency of the blood to clot inside the vessels. Another danger: substances in tobacco smoke may damage the protective lining inside the blood vessels. Inhaling tobacco smoke harms the heart and blood vessels in several ways that are serious enough to provoke a heart attack or other major event. Nicotine increases the heart rate by 15 to 25 beats per minute and blood pressure goes up by 15 to 25 points. Carbon monoxide that builds up in the bloodstream slows the transfer of oxygen to the body. All these changes add up to a greater heart attack risk, especially if the person has other risk factors such as hypertension, diabetes, obesity and an inactive life style. Risk increases with the amount you smoke. If you smoke one pack of cigarettes a day, the risk of cardiovascular disease is twice that of someone who never smoked, and the risk is three times greater for those who smoke two or more packs a day. Women smokers who also use oral contraceptives have a 10-fold higher risk of having a heart attack. Stroke is another reason to call it quits. In the Harvard Nurses' Health Study, an ongoing study begun in 1976, scientists studied more than 100,000 nurses who were then between the ages of 30 and 55 years of age. After monitoring these women over time, the investigators concluded that compared to women who didn't smoke, those who smoked 1 to 4 cigarettes each day had a little over three times the risk of stroke. The risk was nearly four times for those who smoked 5 to 14 cigarettes each day. Although smoking cessation is difficult, it improves cardiovascular health. For someone who has been off cigarettes for one year, the risk of heart disease caused by smoking is cut in half. After 10 years of not smoking, an individual's risk of having a heart attack is about as low as if the ex-smoker had never smoked. The impact of smoking cessation on the risk of stroke is even greater. Smokers who remain smoke free for at least 5 years may be able to reduce their risk of stroke to the same level as someone who has never smoked. These advantages extend to older people. Recent studies have found that smokers over age 60 can add 5 to 7 years to their lives by quitting.

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