A major study published in the BMJ has found that smoking even one cigarette a day carries a substantially increased risk of heart disease and stroke, challenging the notion that cutting down is a safe alternative to quitting. Researchers analysed 141 studies and concluded that there is no safe level of smoking for cardiovascular health.
The study revealed that people who smoked one cigarette daily were about 50% more likely to develop heart disease and 30% more likely to have a stroke compared to never-smokers. For men, the excess risk of coronary heart disease was 48%, while for women it was 57%. The risk of stroke was 25% higher for men and 31% higher for women.
Professor Allan Hackshaw from the UCL Cancer Institute, who led the research, emphasised that heavy smokers often cut back thinking it is sufficient, but for heart disease and stroke, this is not the case. He stated, 'They've got to stop completely.' The study found that men smoking one cigarette per day retained 46% of the excess heart disease risk and 41% of the stroke risk compared to those smoking 20 per day. For women, the figures were 31% and 34% respectively.
Cardiovascular disease is the leading cause of smoking-related deaths, accounting for about 48% of premature deaths among smokers. While the overall smoking rate in the UK has declined, the proportion of light smokers (one to five cigarettes daily) has risen steadily. The researchers noted that a 20-a-day habit would cause seven heart attacks or strokes in a group of 100 middle-aged people, whereas reducing to one cigarette a day would still cause three.
Experts welcomed the findings but offered differing perspectives. Professor Paul Aveyard from the University of Oxford said cutting down with nicotine replacement or e-cigarettes could eventually lead to quitting. Martin Dockrell from Public Health England advised that quitting completely is the safest option. Deborah Arnott of ASH highlighted that vaping is less harmful only if smokers quit entirely, while Simon Clark of Forest warned that discouraging cutting down could be counter-productive.
