Tobacco as a Cardiovascular Risk Factor

Abstract

Tobacco use in the form of cigarettes has long been established as a major risk factor for coronary heart disease (CHD). It is the most preventable cause of mortality. Each year, cigarette smoking causes more than 400,000 deaths in the United States alone, more than the number of American lives lost during World War I, Korea, and Vietnam combined (1,2). Not only does this modifiable behavior cause pain and suffering, but it poses a significant economic burden. Total US Medicaid expenses caused by tobacco use are more than $6 billion a year (3). Total direct health care costs are in excess of $75 billion a year. Indirect losses, usually because of lost productivity, increase that figure by another $80 billion a year (3,4). For every cigarette pack sold in the United States, the country spends approx $7.18 in health care-related and lost productivity costs (5). In the mid1990s, state attorneys general participated in legal action with tobacco companies in hopes of winning back money spent on Medicaid expenses. In 1998, an out-of-court settlement was reached giving states billions of dollars upfront and billions more in annual payments (6). Since then, most states have failed to allocate the Centers for Disease Control and Prevention-recommended funding for tobacco prevention, despite the fact that states are taking in record amounts of tobacco-generated revenue from the settlement and from increased cigarette taxes (7).