Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

SMOKING CESSATION & RISK OF DEATH

Smoking, as we all know, is associated with an increased risk of cancer, cardiovascular disease, non-cancer lung disease, and early death.  It is also widely known that smoking cessation will, over time, lead to a reduction in smoking-associated health risks.  However, the extent of this reduction, and the duration of smoking cessation required to realize significant health benefits, has not been entirely clear.  Now, a new clinical research study from the Washington University School of Medicine and Harvard University, and published in the Journal of the American Medical Association, provides important data that directly addresses these critical questions.  This study was part of a much larger overall study, the Nurses’ Health Study, and includes more than 100,000 female nurses who have participated in this prospective clinical research trial since 1980. 

In this particular clinical study, a total of 12,483 women died during the course of the parent study.  Among the women who died, 36% were “never-smokers,” 29% were active smokers, and 35% were prior smokers who had previously quit.  When all 104,519 women participating in this huge study were evaluated, active smokers were found to be almost 3 times more likely to die (of any cause) than “never-smokers.”  When the researchers looked at the incidence of cancers known to be associated with smoking, the active smokers had more than 7 times the risk of these cancers than were observed among the women who have never smoked.  Even those cancers not definitively associated with smoking were still more commonly observed among the active smokers, occurring approximately 1.6 times more frequently in this group when compared to the “never-smokers.”  When compared to “never-smokers,” the incidence of colon and rectal cancer was observed 1.6 times more frequently among the women who were active smokers, and 1.2 times more often among the women who had smoked in the past but previously quit.  Death due to lung disease (other than cancer) was (not surprisingly) also significantly more common among the women who were active smokers.

Based upon the results of this long-term prospective study, a full 20 years of smoking cessation was necessary before death rates in previous smokers fell to the level observed among “never-smokers.”  Strikingly, when the actual causes of death were assessed, this study concluded that 64% of the deaths observed among the actively smoking women were directly attributable to cigarette smoking, while 28% of the deaths observed among the former smokers were smoking-related.

This study is very valuable from a public health perspective, as it relies upon a very well designed and managed prospective clinical research trial, with long-term follow-up, to provide high quality clinical data.  In doing so, the statistics derived from this study are both sobering and likely to be valid.  What is abundantly clear is that smoking is a potent cause of otherwise preventable and early deaths.  What is also clear is that the earlier one starts smoking, and the longer one continues to smoke, the greater the risk of chronic illnesses and early death.  On the other hand, quitting smoking can, over time, reduce the excess risk of illness and death associated with smoking.  This risk reduction begins immediately after smoking cessation, but it appears to take approximately 20 years before all of these smoking-related health risks disappear entirely.  The lesson is simple, really.  You are much better off, health-wise, if you never start smoking.  However if you are already a smoker, quitting (and quitting right now) will allow you to begin that long but worthwhile journey back to the level of health risk that you would otherwise have enjoyed had you never started smoking in the first place.

CHILDHOOD TRAUMAS & ADULT SUICIDE RISK

The experiences that we have during the pivotal developmental years of our childhood can have an enormous impact on our adult lives.  Many among us struggle, consciously or subconsciously, late into life with the adverse experiences of our early years.  A new clinical study from the University of California at San Diego, and from several medical centers in Canada, and just published in the American Journal of Public Health, further illuminates this very private arena of our lives, and the results of this study are rather sobering.  Using data from a large mental health study, sponsored by the National Institutes of Health, in which nearly 10,000 adult men and women volunteered to take a detailed survey within their homes, this particular research study was designed to assess the impact of childhood traumas on mental health and suicide risk during adulthood.  The specific types of adverse childhood experiences assessed included physical abuse, sexual abuse, and the witnessing of domestic abuse. 

Based upon the data collected during this study, the researchers estimated that 22% to 32% of the psychiatric disorders observed in the women volunteers were associated with adverse childhood events, while 20% to 24% of the mental illness observed in the male volunteers appeared to be associated with traumatic childhood experiences.  Suicidal thoughts and actual suicidal attempts in women appeared to be linked to adverse childhood events in 16% and 50% of such cases, respectively, and in 21% and 33% of men, respectively.  Increasing numbers of traumatic events experienced during childhood also appeared to be associated with an increasing risk of psychiatric illnesses and thoughts of suicide (or actual suicidal attempts). 

While mental health studies, such as this one, rely on far more subjective findings than most non-psychiatric clinical research studies, the results of this study nonetheless provide at least a semi-quantitative estimate of the contribution of traumatic childhood illnesses to those people already suffering from mental illness, including those who have either contemplated or actually attempted suicide.  While there are many among us who have suffered tremendously adverse experiences during childhood, and who nonetheless have progressed into adulthood without any obvious evidence of any mental health difficulties, clearly, there many people who continue to struggle with the impact of such early-life experiences throughout their adult lives.  If you are one of those people who struggle with depression, poor self-esteem, chronic anxiety, or other troubling symptoms of poor mental or emotional health, then I urge you to seek help from your personal physician, or from a mental health professional.  The same goes for the thousands of young men and women who are returning from the battlefields of Iraq and Afghanistan with post-traumatic stress disorder symptoms.  If you are feeling badly, please get help, now.

“WHITE COAT” HYPERTENSION & CARDIOVASCULAR DISEASE RISK

Most physicians are very familiar with the “White Coat Syndrome.”  Patients who are anxious about their visits with their doctor often have evidence of increased adrenaline secretion, which typically manifests as anxiety, sweating, a rapid pulse, and elevated blood pressure.  In most cases, after the patient has become more comfortable with their physician, these signs of an overactive sympathetic nervous system begin to subside.  I often see this “syndrome,” particularly in patients seeing me for the first time, or in those who have returned to see me for results of biopsies and other surgeries.  Since I am exclusively a cancer physician and surgeon, the stakes for most of the patients who I see are very high, and many of them are, understandably, very anxious about both the reasons for their visit with me and the potential outcomes of their visit.  I, and many other physicians, have also noted that patients with minimal or very mild baseline hypertension often experience significant “White Coat Syndrome,” particularly with respect to their blood pressure readings at the beginning of their visits with us. 

A newly published clinical study, in the European Journal of Internal Medicine, looks more closely at the relationship between “White Coat Syndrome” and the presence or absence of cardiovascular disease.  In this study, 100 patients already suspected of having coronary artery disease (but never diagnosed) underwent blood pressure measurements, for 24 hours, in an ambulatory clinic, and then underwent ultrasound evaluation of their hearts and carotid arteries (the large arteries in the neck the supply the majority of the blood flow to the brain).  Additionally, these patients also underwent coronary artery angiograms to further assess their coronary arteries. 

This study determined that the patients who presented with “White Coat Syndrome” in the ambulatory clinic were significantly more likely to have coronary artery disease than those patients who, despite already being suspected of having coronary artery disease, presented with normal blood pressure measurements.  Likewise, in the group of patients who initially presented with elevated blood pressure readings, the incidence of abnormal heart function and narrowed carotid arteries (from atherosclerosis) was significantly greater than was observed in the patients who did not initially present with high blood pressure readings. 

In summary, among 100 patients suspected of having coronary artery disease, those who presented initially with elevated blood pressure readings were much more likely to have significant coronary artery disease, abnormal heart function, and narrowed carotid arteries than those patients who presented, initially, with normal blood pressure readings.  Based upon the results of this study, the presence of “White Coat Syndrome” may, at least in some patients, be a harbinger of underlying cardiovascular disease, in addition to being a manifestation of patient anxiety during their visit with their doctor.

 

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net

http://www.doctorwascher.com

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

Tags: abstinence, adverse, artery, atherosclerosis, cancer, cardiovascular, carotid, cessation, childhood, cigarettes, colon, coronary artery, death, disease, events, high blood pressure, hypertension, illness, lung, mental health, narrowing, psychiatric, quitting, rectal, risk, smoking, stenosis, suicide, syndrome, tobacco, trauma, traumatic, white coat

This entry was posted on Sunday, May 11th, 2008 at 6:31 pm and is filed under Family, Health, Science & Nature, Society, Vox Populi. You can follow any responses to this entry through the RSS 2.0 feed. | 95 views | Trackback | Print this page |

Cancer surgeon, professor of surgery & author. Webmaster: http://doctorwascher.com | More from Robert A. Wascher, MD, FACS