Smoking has declined over the past 40 years, but 24 percent of adults still smoke and 20 percent of teenagers are likely to start. Smoking increases the risk of blood clots, elevates blood pressure, and damages the lungs, which makes it harder to exercise. As a result, smokers are two to four times more likely to develop heart disease, and as many as 30 percent of all coronary heart-disease deaths in the U.S. each year stem from cigarette smoking. Even exposure to secondhand smoke can damage blood vessels, potentially increasing the risk of a heart attack.
Quitting smoking lowers your heart-disease risk dramatically. The longer you've quit, the lower that risk is likely to become. And it can be done: Some 50 percent of all Americans who ever smoked have managed to quit permanently—though they often need help from counseling, medication, or both to overcome it.
Even "light" smoking (one to four cigarettes a day) increases the risk of heart disease and premature death in men and women, and it increases the risk of lung cancer in women, evidence shows. While less smoking is certainly better than more, strong research has found that it’s no match for quitting.
In a study involving more than 100,000 people, for example, the number of years spent smoking increased the risk of death from lung cancer more than the number of cigarettes smoked each day. The good news is that the less you smoke, the easier it is to stop.
Certain drugs can ease cravings for nicotine. Two antidepressants—bupropion (Wellbutrin SR, Zyban, and generic) and nortriptyline (Pamelor and generic)—seem to work by stimulating some of the same brain chemicals that cigarettes do. Another medication called varenicline (Chantix) provides mild nicotine-like effects while potentially blocking some of the satisfaction cigarettes provide.
But bupropion and varenicline now carry a black-box warning, the most serious caution, because of reports of increased thoughts of suicide and actual attempts in those taking the drugs, especially varenicline. Given those concerns, we think people should talk with their doctor about safer alternatives.
Most people—particularly those who smoke a pack or more per day—need counseling, medication, or both in order to overcome it. Start by seeing a doctor who can direct you to a counselor or therapist who specializes in helping people stop smoking. Your doctor can also help you decide whether you need drug therapy, too.
The Food and Drug Administration today said smoking cessation drugs varenicline (Chantix) and bupropion (Zyban and generics) must now carry a "black box" warning that they can increase the risk of psychological side effects. These include unusual changes in behavior, hostility, agitation, depressed mood, suicidal thoughts, and attempted suicide.
People who are taking Chantix or Zyban and "experience any serious and unusual changes in mood or behavior or who feel like hurting themselves or someone else should stop taking the medicine and call their health-care professional right away," the FDA says. Additionally, if friends and family members notice these behavioral changes, they should counsel the person to stop taking the drug and call his or her doctor.
Talk to your doctor to choose the best drug therapy to help you quit smoking. There are a number of time-tested treatments that can be effective, including nicotine replacement therapies. Chantix and bupropion may be effective, but you might want to try safer alternatives first. If you do use these treatments, make sure you are aware of the warning signs and are monitored closely for side effects.
Nicotine-replacement products—including over-the-counter patches, chewing gums, and lozenges—help most during the first two to three months, when the risk of relapse is highest. People who continue to experience intense cravings may need to use the products longer, but they should do so under a doctor's supervision because of the risk of addiction to the replacements themselves.
Consumer Reports. Quit smoking: Kicking the habit can slash your risk of heart attack and stroke. Published February 2013.
Consumer Reports. FDA warns of dangerous side effects of smoking cessation drugs. Published July 2009.