Smoking has declined over the past 40 years, but 24 percent of adults still smoke and 20 percent of teenagers are likely to start. Smoking increases the risk of blood clots, elevates blood pressure, and damages the lungs, which makes it harder to exercise. As a result, smokers are two to four times more likely to develop heart disease, and as many as 30 percent of all coronary heart-disease deaths in the U.S. each year stem from cigarette smoking. Even exposure to secondhand smoke can damage blood vessels, potentially increasing the risk of a heart attack.
But quitting smoking drops your heart-disease risk dramatically. The longer you've quit, the lower that risk is likely to become. And it can be done: Some 50 percent of all Americans who ever smoked have managed to quit permanently—though they often need help from counseling, medication, or both to overcome it.
Start with lifestyle changes. A positive attitude is key to successful smoking-cessation efforts. So replace "shouldn'ts"—"I shouldn't smoke so much"—with affirmatives—"I will stop smoking."
Get the right treatment. Most people—particularly those who smoke a pack or more per day—need counseling, medication, or both in order to overcome it. Start by seeing a doctor who can direct you to a counselor or therapist who specializes in helping people stop smoking. Your doctor can also help you decide whether you need drug therapy, too.
Nicotine-replacement products—including over-the-counter patches, chewing gums, and lozenges, and prescription nasal sprays or inhalers—help most during the first two to three months, when the risk of relapse is highest. People who continue to experience intense cravings may need to use the products longer, but they should do so under a doctor's supervision because of the risk of addiction to the replacements themselves.
Certain other drugs can ease cravings for nicotine. Two antidepressants—bupropion (Wellbutrin SR, Zyban, and generic) and nortriptyline (Pamelor and generic)—seem to work by stimulating some of the same brain chemicals as cigarettes do. Another medication called varenicline (Chantix) provides mild nicotine-like effects while potentially blocking some of the satisfaction cigarettes provide.
But bupropion and varenicline now carry a black-box warning, the most serious caution, because of reports of increased thoughts of suicide and actual attempts in those taking the drugs, especially varenicline. Given those concerns, we think people should talk with their doctor about safer alternatives.