Abstract

Introduction

ATHEROSCLEROSIS has become a major health problem in Indian patients now a day. It results in coronary artery disease leading to myocardial infarction (MI) and carotid artery occlusion causing strokes and cerebrovascular accidents .The terms atherosclerosis was coined by Jean-Frederick Lobstein (1833). William Potter (1893) provided experimental evidence of occlusion of coronary arteries resulting in death due to myocardial infarction. Initially there was impression that atherosclerosis is an age related degenerative process which affects the person of affluent society mainly obese, sedentary and stressed males. Now a day many study has discovered that smoking is also an important and preventable cause of cardiovascular morbidity and mortality in Indian population. In India, smoking in the form of cigarette in high income group patients and bidi in lower socio-economic group is very popular particularly in stressed person. There are several factors to explain atherosclerosis among Indians population: sedentary life, rapid urbanisation, industrialisation and singular family concept resulting in stress, faulty lifestyle, smoking, also there is inherent genetic predispositions to cardiovascular disease, dyslipidemia and central obesity. Out of these smoking and tobacco consumption-have played the crucial and additive role in stressed personality person.  According to the World health organisation South- East Asia Regional office cardiovascular disease caused 3.493 millions death in this region out of which coronary artery disease account for 1.706millions death. A total of 1.375 millions deaths occurred in India alone because of cardiovascular disease.  It was estimated that the incidence of cardiovascular disease would increase from 2.90 crore in 2002 to about 6.40 crore in 2015. It was observed that by the year 2020, coronary heart disease and stroke would occupy the first and fourth places as the leading causes of disability and mortality in Indian. India is one of the largest producer and exporter of tobacco in the world. Smoking leads to coronary artery occlusion and constriction, tachycardia, platelet adhesions and aggregation, activates caspase-3 which induces apoptosis of endothelial cells. Smoking also impairs the activity of endothelial nitric oxide synthase.  It promotes the dyslipidemia (i.e. LDL-C). It promotes LDL-C oxidation and decreases HDL.  It is responsible for increased plasma fibrinogen and catecholamine which causes systemic vasculitis. It accelerates the aging process, facilitates mutant gens for insulin resistance syndrome (IRS) and hence increases the rate of diabetes among smokers.  In this way smoking is largely responsible for the hypertension, premature atherosclerosis and many cardiovascular and cerebrovascular disorders like myocardial infraction and strokes respectively. Tobacco smoke is complexed, dynamic and reaction mixture containing nitrosamines (alkaloid). Many of them can harm our body in various ways. Tobacco smoking is well known modified risk factor for atherosclerosis, coronary heart disease, lung and oral cancers, chronic obstructive pulmonary diseases, etc. Nicotine is one of the toxins present in tobacco smoke. It is found to have effects on catecholamine and cortisol secretion. Elevated catecholamine and cortisol secretion can alter carbohydrate and lipid metabolism in such person.  Alteration in lipid metabolism may lead to dyslipidemic changes which may become a predisposing factor for atherosclerosis and ischemic heart disease leading morbidity and mortality in smokers.