Thread by @Basalus

1/ 🚭 Quitting smoking is one of the most powerful interventions for cardiovascular health. Whether young, old, or already diagnosed with heart disease, stopping smoking dramatically reduces heart attacks, strokes, heart failure, and death. Let’s dive into the evidence. 🧵

2/ Rapid Risk Reduction
Within months of quitting, blood pressure, vascular function, and clotting markers improve.
Within 1 year, coronary heart disease (CHD) risk is ~50% lower vs. continued smoking.
Within 5 years, CVD event risk drops ~39% in heavy smokers. (Duncan et al. JAMA 2019)

3/ Long-Term Gains
10–15 years after quitting, CHD and stroke risk approaches that of never-smokers.
Framingham data: after 15 years, no excess CVD risk remains in moderate ex-smokers.
Even heavy ex-smokers see major reductions, though not to baseline. (Jha et al. NEJM 2013)

4/ Heart Attack & CHD Risk
Quitting reduces CHD risk by ~50% within 1–2 years.
Among heavy smokers (≥20 pack-years), cessation led to a 61% drop in heart attack, stroke, or CVD death risk within 5 years.
By ~13 years, risk was no different from never-smokers. (Duncan et al. JAMA 2019)

5/ Stroke Risk Decline
After quitting:
🧠 5+ years → Stroke risk nears never-smoker levels
🧠 10–15 years → Elevated risk essentially disappears
Even after prior CVD, quitting lowers secondary stroke risk by ~30%. (Zhou et al. Lancet 2019)

6/ Heart Failure & Other Heart Diseases
Smoking causes heart failure via CHD, hypertension, and direct toxicity.
After 15 years, moderate ex-smokers reach never-smoker HF risk.
Heavy ex-smokers retain some excess risk but still far lower than continuing smokers. (Yinyin et al. Circ HF 2017)

7/ Overall Cardiovascular Mortality
Among CHD patients, quitting reduced:
💀 Cardiac death by ~40% (Cochrane 2021)
💀 All-cause mortality by ~40%
In the general population, quitting by age 40 avoids ~90% of excess mortality. (Jha et al. NEJM 2013)

8/ What About Weight Gain?
Quitting may lead to modest weight gain, but:
✔️ CVD risk still drops significantly
✔️ Even with weight gain, CVD & all-cause mortality ↓ (Wang et al. Nicotine Tob Res 2021)
✔️ Smokers with diabetes still benefit from quitting. (Hu et al. NEJM 2018)

9/ Take-Home Message
✅ Stopping smoking improves heart health at any age
✅ Quitting before 40 prevents ~90% of excess mortality
✅ CHD, stroke, HF risk drop fast and approach never-smoker levels over time
✅ It’s never too late to quit—even late-life quitting saves lives

10/ Final Thought
“The single best thing a smoker can do for their heart is to quit smoking.”

🚭 Quit today. Live longer. Keep your heart healthy.

References 🧵⬇️

11/ Key References (Lancet style)
1️⃣ Duncan MS et al. JAMA. 2019;322(7):642-650.
2️⃣ Hu Y et al. NEJM. 2018;379(7):623-632.
3️⃣ Yinyin J et al. Circ HF. 2017;10(6):e003bhj.
4️⃣ Cochrane Tobacco Addiction Group. Cochrane Database Syst Rev. 2021;3:CD010212.
5️⃣ Jha P et al. NEJM. 2013;368(4):341-350.
6️⃣ Gomez A et al. J Am Heart Assoc. 2018;7(13):e008819.
7️⃣ Wang X et al. Nicotine Tob Res. 2021;23(11):1987-1994.
8️⃣ Zhou X et al. Lancet. 2019;394:2547-2556.