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Attn. Mr. President: Some of the lethal effects of smoking come pronto

REUTERS/Alex Grimm

President Barack Obama won't commit to saying that he's quit smoking, which is to say he's apparently still smoking.

In December, when Tom Brokaw asked if he had actually quit, Obama answered, "I have," and then clarified (retracted?) that by saying, "What I said was that there are times where I have fallen off the wagon."

"Wait a minute," said Brokaw. "That means you haven't stopped."

"Fair enough," Obama said. "What I would say is that I have done a terrific job under the circumstances of making myself much healthier. And I think that you will not see any violations of these rules in the White House."

President Obama has been true to his word in that regard, but it appears he's still smoking somewhere, at some rate; a month ago he told CNN's Anderson Cooper that he hadn't smoked on the White House grounds, and left it at that.


A cost-cutting safety idea
So as long as Obama is still smoking, and our country's economy is in what experts now describe as "the toilet," let me offer one cost-cutting move: Pare down the president's Secret Service detail a bit and funnel some of the savings into buying smoking-cessation aids: gums, pills, patches, whatever.

What are his risks? At Obama's age (47), according to data from the National Vital Statistics System, from the National Center for Health Statistics at the CDC, cancer is the most common cause of death, followed by heart disease. Both of those have cigarette smoking as a major risk factor, which is why smoking remains the No. 1 cause of preventable death in this country.

OK, so the president is sneaking a few cigarettes in the lavatory of Air Force One. Who cares? A few puffs here and there might lead to problems in the future, but at that rate, he's not going to get cancer or clog up the pipes any time soon. Right?

Risk from smoking is different for heart attacks
Right and wrong. That's true in the case of cancer, where the risk increases linearly with the degree of cigarette smoke exposure — the more you smoke, the higher the risk of getting cancer. But that's not true for smoking and heart attacks, where the risk of finding an elephant sitting on your chest increases rapidly with just one or two cigarettes a day. At five cigarettes a day or higher, the risk of having a heart attack levels off and becomes linear again — the more you smoke, the higher the risk.

We know that tobacco smoke leads to atherosclerosis — scarring and narrowing of the inner lining of the arteries — by a variety of mechanisms, but its effect on blood cells called platelets seems to play a crucial role in the acutely detrimental effects of smoking.

The primary function of platelets is to form blood clots; when they sense a rough, damaged area in a blood vessel, they clump together to form a patch until the damage can be repaired. This is good news if you've happened to cut yourself with a pair of scissors, but smoking makes platelets extra sticky, and that's bad news if you're worried about a heart attack. That's because most heart attacks occur when platelets reflexively form a blood clot over an area of an artery that's been damaged by atherosclerosis. A blood vessel that was only partially blocked by atherosclerotic debris suddenly becomes completely blocked by a combination of atherosclerosis and platelet clot. Heart muscle downstream from the blockage dies.

An exaggerated propensity to clot
Although drugs like aspirin or plavix help prevent heart attacks by making platelets less sticky, tobacco smoke has the opposite effect. This exaggerated propensity to clot may explain why smokers who've suffered a coronary artery blockage/heart attack are more commonly found to have a large blood clot stuck to a small clump of atherosclerosis. It's why they respond better to medications called "lytics," drugs that can rapidly dissolve clots and thereby reopen arteries. Non-smokers, on the other hand, tend to have smaller blood clots over larger atherosclerotic lesions, and don't respond as well to lytics.

Besides this platelet effect, smoking acutely sickens and inflames the inner lining of the blood vessel, increasing the likelihood of heart attack. On top of all this, nicotine — the addictive culprit in smoking — increases adrenaline levels, raising blood pressure and pulse and increasing the workload of the heart. I would think being president of the United States does enough to raise one's adrenaline levels.

It is these acute effects of smoking that may explain why, among all heart-attack sufferers, smokers seem to be younger (11 years younger in one major study) and have lower rates of diabetes and hypertension — the conditions that promote atherosclerosis. And the fact that the bulk of the cigarette-induced heart-attack risk occurs at relatively low levels of exposure is also consistent with the disproportionate risk seen in secondhand smokers: A little goes a long way.

Given all of this, it seems ironic that we would spend millions protecting the president from assassination plots, when, statistically speaking, the assassin might well be lying in wait in his suit coat pocket. If President Obama is serious about being a part of the solution to our country's problems, he'll need to completely conquer his addiction to nicotine, and thereby rid himself of the mortal danger that cigarette smoking brings with it, right now, even with just a few cigarettes.

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Comments (4)

The health police are on the prowl.

You bet we are, Gotzman!

(grin)

Please pull over. I'd like to see your driver's license and your health insurance card, and check your teeth for staining.

"Pare down the president's Secret Service detail a bit and funnel some of the savings into buying smoking-cessation aids: gums, pills, patches, whatever," might help some people.

So might this--written in 1960 before any of them existed, "The Five-Day Plan to Quit Smoking." To paraphrase Joni Mitchell, "None of the crazy you get from too much help."

http://www.uhs.wisc.edu/docs/5_days_quit_smoking.pdf

My ninth try is doing much better. Thank you for the article, Dr. Bowron.