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Women with High Blood Pressure Who Smoke Have Greater Risk of Aneurysm

Monday, December 16th, 2013

Subarachnoid hemorrhage (SAH) is a cerebrovascular catastrophe that kills 40 to 50 percent of sufferers. A ruptured intracranial aneurysm is the most common cause of SAH. Sometimes, aneurysms are found and treated before they have a chance to rupture. Furthermore, some aneurysms will never rupture. However, there is no way to tell which ones will and which ones won’t. In addition, research now shows that women who smoke and have high blood pressure are more likely to develop SAH. Twenty times more likely!

This discovery is important because it sheds some light on how to decide whether to treat a person with an unruptured intracranial aneurysm. If we know that a female patient with high blood pressure who smokes is significantly more likely to develop SAH than a male patient with normal blood pressure who doesn’t smoke, and intracranial aneurysms are found in both, then it may be that the woman needs to be treated while the man does not. This is an important step in being able to predict which aneurysms are likely to rupture and which aren’t.

The study also revealed three previously unknown risk factors for SAH: elevated cholesterol levels in men, and maternal history of stroke and previous heart attack in either gender. These results show that the risk factors for SAH appear to be similar to the risk factors for other cardiovascular diseases.

It is already known that lifestyle risk factors have a significant impact on the life expectancy of a person who has survived SAH. Now, it is becoming clear that those same risk factors increase the risk of SAH in the first place. Therefore, quitting smoking and taking steps to lower high blood pressure are especially important in both preventing SAH and increasing life expectancy if it does occur.

Of course, this is just one more item to add to the list of reasons why you should quit smoking. Smoking is a well-known health risk that people can choose not to expose themselves to. Cigarettes contain over 4000 chemicals, at least 400 of which are known toxic substances.

Among the most harmful products in cigarette smoke are tar, which is a carcinogen; nicotine, which is addictive and is thought to increase cholesterol levels and carbon monoxide, which replaces oxygen in your bloodstream. An individual’s overall health risk from smoking depends upon a number of factors, including how much the individual smokes, whether the cigarette has a filter, and how the tobacco has been prepared. More research is needed before it will be clear whether these same factors affect a person’s SAH risk.

As for hypertension, it is known to be potentially damaging to several body systems, including the arteries, heart, brain, and kidneys. Talk to your doctor about your blood pressure and/or smoking to find solutions for lowering your blood pressure, helping you quit smoking, or both.

– Yvonne S. Thornton, M. D., M. P. H.

High Rate of Smoking Relapse After Pregnancy and Delivery

Monday, August 5th, 2013

It is no secret that smoking can have an incredibly harmful effect on a growing fetus. Smoking during pregnancy can lead to major problems, from fetal deformities to miscarriages and stillbirths. All women are encouraged to quit smoking well before conceiving, and those that do not are encouraged to quit smoking as quickly as possible after discovering that they are pregnant. There are many intervention programs in place to help women who smoke quit during pregnancy. However, there has been a lot of concern in recent years that smoking cessation during pregnancy is not permanent.

Studies have shown that upwards of 48 percent of women who do quit smoking during pregnancy will relapse afterwards, with a sharp increase in relapse occurring up to a point about six months after delivery. Traditional intervention programs designed to help women quit smoking during pregnancy have shown low success rates in helping a woman quit smoking overall.

This is important because the risks of second-hand smoke are still much higher than is safe, especially with the association of second-hand smoke and the development of childhood asthma. Women are encouraged to make every attempt to quit smoking, not only for their own health, but also for the health of their families.

It is becoming increasingly obvious that quitting during pregnancy—when there is a strong motivation to quit—does not have the lasting effects that could be hoped for. Additionally, the stressful time after delivery is often debilitating to a woman’s efforts to remain nicotine-free.

It is strongly suggested that women who quit smoking during pregnancy seek some sort of aid, counseling, or even medical intervention after delivery in order to prevent smoking relapse. There are a number of products and coping strategies available that can help. While it is admirable to want to quit, it may not be wise to attempt to go “cold turkey”, even for women who have gone without a cigarette for up to, or over, nine months.

Women should remember that their lives change in many ways after they deliver a child. The coping strategies a woman develops during pregnancy may not work in the postpartum period, especially without the motivation of being pregnant to prevent smoking relapse. As a woman’s Ob-Gyn will most likely be the doctor a woman sees the most during the postpartum period, they are an incredible resource for helping their patients stay off the cigarettes for good.

I have helped many women quit smoking in my years as a doctor, and with help a good number of those women never smoke again.  Women need to take extra steps to quit smoking permanently to ensure both their health and that of their families.

– Yvonne S. Thornton, M. D., M. P. H.


Should You Stop Smoking to Start Birth Control?

Monday, November 26th, 2012

You already know that smoking is bad for your health. If you’re a smoker, you’re already making the choice to ignore certain health warnings that could significantly alter your health for the rest of your life, and that’s a choice that no one else can make for you.  My telling you about all of the risks associated with smoking cigarettes would be a waste of time. However, I do feel it’s important that you know the increased risks associated with oral contraceptives for women who are smokers.

For the most part, modern oral contraceptives are safe. Even problems that have been tied to birth control for decades are now less common as the medicine improves and doctors work towards making the pill safer and with fewer side effects. However, by smoking while taking contraceptives, you’re increasing your risk for complications in multiple ways. Blood clots and stroke are both much more common in women taking birth control and smoking, especially in women who are 35 years old or older.  In fact, there is a ten-fold increase of death attributed to cardiovascular disease and the use of oral contraceptives in women who smoked above the age of 35 years.  [Link:]

The biggest risk for women who are smoking while on the pill is any cardiovascular complication and you’re increasing your risk by simultaneously restricting your blood vessels with the tobacco. The exact mechanism is not known as to the etiology of the increased risk, but according to a recent study, the risk of death due to such complications is low for women under 35 years old. Women who smoke while taking birth control are at a higher risk for heart attacks, high blood pressure, and increased blood vessel tension.

I’m not going to tell you to stop smoking, though as a physician, I certainly think you should. However, I urge you to take a closer look at the risks and benefits when it comes to combining your birth control with tobacco. If you feel that you need to continue smoking while taking your  oral contraceptives, consider looking other types of birth control that don’t use hormones, such as an intrauterine device or even the old tried and true diaphragm.

 – Yvonne S. Thornton, M. D., M. P. H.


Lung Cancer in Women is on the Rise in the South

Monday, July 9th, 2012

Have you seen an anti-smoking ad recently?  Odds are, you probably have not, and if you have seen them, there most likely haven’t been many.  About twenty years ago, anti-smoking campaigns were extremely prevalent due to the high numbers of lung cancer deaths related to the habit.  As a result, both smoking and lung cancer have declined significantly.  At least, they’ve declined in most places around the US.  Unfortunately, statistics are now showing that in the south and some parts of the Midwest, lung cancer among women is once again on the rise.

According to the Journal of Clinical Oncology, the risk of dying from lung cancer was highest in women born in the 1930s, but that rate dropped in the following decades.  Among the baby boomer generation, that rate has dropped further or remained low, except for in southern and Midwestern states.  For example, in Alabama, lung cancer deaths increased from 6.9% to 10.7% as opposed to rates in California which fell from 6.1% to 2.8%.  These statistics came about after a 23 state comparison meant to find out the current rates of lung cancer in connection to smoking.  There is much speculation as to the causes of these differences which appear to be regional issues.  Some experts believe it is due to a letting up of anti-smoking campaigns and strategies like cigarette taxation.  Others though, feel that a study on the availability and cost of health care for lung cancer treatment in those areas is needed to determine if that may be the actual cause.

No matter the reason for these regional differences, there is obviously still a significant amount of the population who are smokers and who ignore the warnings about the harmful effects of such a habit.  It’s likely to take both an improvement in the medical care available in those areas as well as an anti-smoking campaign as aggressive as California’s to make any kind of difference.  In the meantime, it’s up to parents like us to continue to warn our children to stay away from tobacco products.


– Yvonne S. Thornton, M. D., M. P. H.