Although the number of people who smoke has been on the decline for decades, 12.5 percent of American adults age 18 or older — an estimated 30.8 million people in the United States — still light up, according to the Centers for Disease Control and Prevention (CDC). (1) Indeed, smoking is one of the worst habits for a person’s health: It affects nearly every organ in the body and is a significant risk factor for a laundry list of health conditions and diseases. Smoking is also the leading preventable cause of death in the United States, and is responsible for more than 480,000 deaths in the country each year. (1) When it comes to heart and vascular health, smoking is a proven risk factor for the formation and rupture of both cerebral and aortic aneurysms. (2,3) Smoking is a also a more significant risk factor for abdominal aortic aneurysms than for atherosclerosis, a disease in which plaque builds up in the arteries. (3) Smoking also causes a temporary spike in blood pressure, which can weaken the arterial walls and make them more prone to form an aneurysm and rupture, Dr. Brown says. The exact mechanism of how cigarette smoking leads to aneurysm formation is unknown. It may involve decreasing the effectiveness of alpha-1 antitrypsin, an important inhibitor of proteases like elastase. Studies also show that smokers have higher levels of cytokines, or small proteins released by the cells that have an effect on the interaction and communications between cells. (4) The specific cytokines found in smokers may be related to the formation of cerebral aneurysms, a condition in which an artery in the brain bulges. (2) According to a study published in the Journal of Neurology, Neurosurgery & Psychiatry, smokers who had a brain aneurysm were three times more likely than nonsmokers to have a subarachnoid hemorrhage (SAH). (6) Another study, published in the Journal of Neurosurgery, found people who suffered a brain aneurysm, underwent endovascular (EVAR) repair — a procedure that uses a catheter inserted into the artery to place a stent — and continued to smoke had a nearly threefold increase for risk of recurrence. Former and current smokers had an about 26 percent rate of recurrence, while newer smokers had an about 17 percent rate of recurrence. (7)
Aortic Aneurysms
According to a study published in the journal Arteriosclerosis, Thrombosis and Vascular Biology, 1 in 17 people who are current or former smokers have a lifetime risk for developing an aortic abdominal aneurysm, a condition in which a bulge forms in the section of the aorta, the main artery in the body. (8) People who already have abdominal aortic aneurysms and continue to smoke are at an increased risk for the aneurysm expanding and rupturing. According to a meta-analysis published in the British Journal of Surgery, 35 percent of smokers who had a small abdominal aortic aneurysm between 3 and 5.5 centimeters were at risk of the aneurysm expanding. (9) Smokers who quit are also at risk. According to a study published in the journal Circulation, people who stopped smoking 10 to 19 years earlier were still nearly three times as likely as nonsmokers to develop abdominal aortic aneurysms. (10) There is no theory or research to support why this disparity exists, says George P. Teitelbaum, MD, an interventional neuroradiologist in Santa Monica, California. But regardless of sex, the length of time spent smoking and the number of cigarettes are factors directly related to the risk for aneurysm. (3)
The Role of Family History and Genetics
In some people, the combination of genetics and smoking can significantly increase the risk of a brain aneurysm. According to research presented at an American Stroke Association’s International Stroke Conference, those people who carried a copy of a risky gene variation were between 37 and 48 percent more likely to develop an aneurysm than those without the gene variant. Those who had the gene variant and also smoked the equivalent of one pack of cigarettes a day for 20 years had a nearly fivefold risk. Those with two copies of the gene variant had an even higher risk. (5) Another study published in the journal Neurology found smokers who have a family history of brain aneurysm are significantly more likely to suffer a stroke from a brain aneurysm themselves. (12) One of the best ways to reduce your risk for an aneurysm is to stop smoking. According to the study in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, middle-aged smokers who had a 1 in 9 chance of developing an abdominal aortic aneurysm reduced their risk of an aneurysm by 29 percent if they quit during the study period. (8) The study in Neurology, Neurosurgery & Psychiatry showed people who quit smoking for five or fewer years were 59 percent less likely afterward to suffer a subarachnoid hemorrhage. (6) There are also effective treatments and resources available, such as prescription medication and over-the-counter products, like nicotine gum, patches, and lozenges. Ask your doctor about smoking cessation programs and providers who offer counseling, which in combination with medication is more effective than either one alone. (14) 1-800-QUIT-NOW (1-800-784-8669) is a free, phone-based service that offers information, coaches, a quit plan, and referrals to local resources. It’s also important to avoid secondhand smoke, which can have the same effect on the blood vessels as actively smoking. Avoid places where smoking is allowed and ask family and friends not to smoke in your home or car.
