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Experts say light smoking carries the same health risks as heavy smoking, just at a lower level. Getty Images
  • New research shows that smoking increases the risk of death through subarachnoid hemorrhage (SAH), a type of brain bleed.
  • Both heavy smokers and light smokers had a higher mortality rate.
  • Light smoking carries the same health risks as heavy smoking, just on a lower level.
  • Experts recommend smokers first make the decision to quit, then follow up with a counselor who may recommend different therapies.

New research shows that the risk of a potentially fatal stroke is elevated by smoking — even for those light cigarette users who aren’t smoking a pack a day.

The data, published today, examined cases of subarachnoid hemorrhage (SAH), a type of brain bleed that can lead to permanent brain damage or even death.

Researchers from the University of Helsinki and Helsinki University Hospital gathered data from a cohort of more than 16,000 same-sex twin pairs to determine if there was an underlying genetic cause that could explain SAH.

It was found that smokers — even those who identified as occasional smokers — were at an increased risk for experiencing SAH.

Among twin pairs where one was a smoker and one a nonsmoker, it was found that the smoker was more likely to experience SAH.

“This fascinating twin study demonstrates that smoking — even light smoking — can cause an increased incidence of stroke,” Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, told Healthline.

“The mechanism for this seems to be independent of hypertension [high blood pressure], although hypertension can lead to stroke,” he added. “Smoking causes a decrease in distensibility in arteries, which may account for this phenomenon.”

Dr. Andrew Rogove, the medical director of stroke services at Northwell Health’s Southside Hospital in Bay Shore, New York, told Healthline that since genetic factors play little role in SAH, it’s important to find environmental factors that can lead to fatal SAH. One environmental factor is smoking.

“Environmental factors can be modified to reduce risk,” he explained. “This study found that in sets of twins where one smoked and the other twin did not, there was a higher death rate due to SAH in the twin that smoked. There was also a correlation with increased alcohol use, but it is postulated that smokers also consume more alcohol. This provides yet another reason to stop smoking.”

It’s been understood for decades that smoking is unhealthy and carries a higher mortality risk than not smoking.

But some occasional smokers may think they’re not at risk because they’re only lighting up every so often.

Nicole Avena-Blanchard, PhD, an assistant professor of neuroscience at the Mount Sinai School of Medicine in New York City, points out that a 2016 study from the National Cancer Institute reported that even smokers who had less than one cigarette per day had a 64 percent higher risk for earlier death than nonsmokers.

“Over time, exposure to the toxins in cigarettes adds up,” Avena-Blanchard told Healthline. “Also, if you only smoke when you drink, for instance, but you drink three nights each week, then you are quickly increasing your risk for smoking-related conditions.”

“The risks for the diseases caused by smoking are the same, but they’d be lower in frequency [for occasional smokers],” Dr. Carolyn Dresler, a retired thoracic surgical oncologist and volunteer with Action on Smoking and Health (ASH), told Healthline.

“Even a single cigarette a day maintains the cardiovascular risk. Also, the risk for lung cancer is more related to the duration of smoking in years versus the number per day.”

Simply put, smoking less frequently does, in fact, carry a lower risk than smoking a pack or two per day, but it still carries a risk.

Dresler notes that the addictive nature of nicotine makes it difficult for many smokers to maintain a lighter smoking regimen.

For those who do smoke occasionally, there’s some good news: It should be easier to quit, since you’re less likely to be affected by severe nicotine withdrawal.

It’s helpful to understand the nature of addiction in the context of quitting smoking.

“Addiction is a brain disease that results from repeated — in some cases, only a few — pairings of a substance with the pleasure and euphoria obtained from using it due to chemicals that are released in the brain,” explained Avena-Blanchard.

“At first, an addict uses because it feels good, but very quickly the addict uses because they feel terrible when they are not using, due to the withdrawal, and are basically just using to feel normal again,” she said.

It can be overwhelming for a light or heavy smoker to deal with the effects of withdrawal while trying to figure out the best course forward.

There are, after all, a wide range of options, from nicotine patches to speaking with a doctor or therapist to simply quitting cold turkey.

Dresler says the first step is relatively simple: deciding to quit, once and for all.

“Most people who smoke want to quit and wish they’d never started as a youth,” she explained. “So, decide.”

Once that decision is made, the real work begins.

“The data shows that quitting with pharmacotherapy and behavioral counseling leads to the greatest success,” said Dresler. “Varenicline and cytisine have the statistically highest quit rates, with counseling, followed by bupropion and nicotine replacement therapy, like patches, gum, and lozenges.”

It’s worth noting, though, that varenicline, which is available by prescription, is expensive and unavailable in some countries. Similarly, cytisine is also unavailable in some countries.

For anyone who’s trying to break the habit but experiences a bump in the road, it’s important to recognize that it’s a normal part of the process.

“Understand that most quits result in relapse,” said Dresler. “This is not a failure. It is a step on the way to a final quit. Quitting smoking is one of the hardest addictions of any drug to break.”

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