Chris Marquette Message Board

Can I just hold up my non-smoking flag for a minute? I read this article in a medical journal the other day and I think we can't show this to people often enough. Not that it really helps, most smokers I know just shrug it off and don't care. And kinda ironic to post this here, too. Because we know pretty sure now that Chris smokes. But anyway...

The heart-breaking news about tobacco: it's all bad

During the present century, about 1 billion people will die of smoking-related conditions if current trends persist; a substantial proportion due to cardiovascular disease.1 In today's Lancet, Koon Teo and colleagues provide a wealth of new data documenting the causal link between smoking and acute myocardial infarction in over 12 000 cases from around the world. Their INTERHEART study used a standardised protocol to select cases and controls, and gather uniform information from 262 sites in 52 countries. The study represents a model for international cooperation, and shows the unique global coverage that permitted investigators to assess a wide range of patterns of tobacco use. The large sample sheds new light on many specific subgroups on the basis of region, age, sex, and form of exposure. The overwhelming conclusion from this mass of data is that tobacco exposure—be it cigarettes, pipes, cigars, beedies, sheesha, or smokeless; second-hand or primary; filtered or non-filtered, even at low levels—causes a large proportion of myocardial infarcts in men and women around the world.

Some aspects of this remarkable study merit special attention. First is the global perspective. Although the adverse effects of tobacco use on cardiovascular disease are well documented in developed countries, far less data are available from developing countries where tobacco use has increased in recent decades. In south Asia, beedies (bidis), tobacco rolled in a dried temburini leaf and tied with a string, are commonly used, but few studies have documented their hazards for heart disease. Rastogi and colleagues reported a relative risk of 8・1 for myocardial infarction from smoking more than ten beedies a day in men in India. Extending the data on beedies, Teo and colleagues found that sheesha, tobacco smoked through a water pipe, has effects similar to other forms of tobacco. Sheesha tobacco had been thought by some as possibly safer, but this view is now refuted.

A second key finding was the close link between amount of exposure and level of risk, which persisted down to very low levels of exposure. Thus even just a few cigarettes a day doubled the risk of myocardial infarction. An increased risk with as few as one to four cigarettes a day has been previously reported, but Teo and colleagues' study extends those findings with greater precision. This result has important clinical and public-health implications for counselling patients. Moreover, the finding that very low levels of active smoking substantially increase risk lends further credence to the plausibility of second-hand smoke  also being a major risk factor. The INTERHEART study adds important information documenting the hazards of second-hand smoke, and confers considerable weight to additional regulations to restrict such exposures. Yusuf and colleagues' report is timely, and complements the 2006 US Surgeon General's report on involuntary exposure to tobacco smoke, which came to similar conclusions.

A third major finding was that much of the excess risk dissipates a year or two after quitting. Some excess risk persists for many years, especially for those who previously were heavy smokers; however, the heavy smokers enjoyed the sharpest decline in risk upon cessation. This non-linear decline in risk over time suggests that at least two different mechanisms are operating to cause myocardial infarction. Further exploration of the details of the decline in risk in this dataset might prove rewarding. The case-control design is superior to most prospective studies in the assessment of the effects of short-term changes in exposure.

The calculations of population-attributable risks from this global study are particularly important. Overall, the population attributable risk for current smoking was 38%. The attributable risk was higher in men than women, despite similar odds ratios in both sexes. This difference in attributable risk reflects the lower smoking prevalence in women. The odds ratios were higher in younger than older individuals, perhaps indicating the lower underlying risk of myocardial infarction in younger persons apart from the risk from smoking, and perhaps also showing some survivor-cohort effect in the older smokers. The latest findings from INTERHEART should stimulate are doubling of our efforts to rid the planet of the scourge of smoking.

Sarah A Rosner, *Meir J Stampfer
Department of Epidemiology, Harvard School of Public Health,
Boston, MA 02115, USA
stampfer@hsph.harvard.edu
From: The Lancet (Volume 368, Issue 9536, 19 August 2006-25 August 2006)

We declare that we have no conflict of interest.
1 Peto R, Lopez A. The future worldwide health effects of current smoking patterns. In: Koop CE, Pearson CE, Schwarz MR, eds. Critical issues in global health. San Francisco: Jossey-Bass, 2000: 151–61.
2 Teo KK, Ounpuu S, Hawken S, on behalf of the INTERHEART Study Investigators. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 2006; 368: 647–58.
3 US Department of Health and Human Services. The health consequences of smoking: a report of the United States Surgeon General. 2004: http://www.cdc.gov/tobacco/sgr/sgr_2004/index.htm (accessed Aug 2, 2006).
4 Rastogi T, Jha P, Reddy KS, et al. Bidi and cigarette smoking and risk of acute myocardial infarction among males in urban India. Tob Control 2005; 14: 356–58.
5 Willett WC, Green A, Stampfer MJ, et al. Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med 1987; 317: 1303–09.
6 US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the United States Surgeon General. June 27, 2006: http://www.cdc.gov/tobacco/sgr/sgr_2006/index.htm (accessed Aug 2, 2006).

I also need to go upload my Adam/Judith no-smoking banner here, but I only have it at home. I'll look for it later.

-TeeJay

Good luck and much success for your job interview this afternoon, Anne!! Kick ass, they need to give you a job! Just be yourself and try not to be too nervous. I know that's easier said than done, but just remember that they're not out to get you or give you grades. They just want to know who you are and if they think you'll fit in at their workplace. It's really not that scary.

Think of Chris and how many auditions he's already had to do. I bet he was nervous for those where he really wanted the part very badly. Just take your James pic with you and look at it for reassurance if you need it.

Show 'em, girl! (Not the picture!)

-TeeJay

So I'm watching Monty Python's Flying Circus as I'm ironing, and there's Graham Chapman, speaking to all the non-Dorquettes:

Voice Over:
And now an appeal for sanity from the Reverend Arthur Belling.

(Cut to studio. A vicar sitting facing camera. He has an axe in his head.)

Reverend Belling:
You know, there are many people in the country today who, through no fault of their own, are sane. Some of them were born sane. Some of them became sane later in their lives. It is up to people like you and me who are out of our tiny little minds to try and help these people overcome their sanity. You can start in small ways with ping-pong ball eyes and a funny voice and then you can paint half of your body red and the other half green and then you can jump up and down in a bowl of treacle going 'squawk, squawk, squawk...' And then you can go 'Neurhhh! Neurhh!' and then you can roll around on the floor going 'pting pting pting' ... (he rolls around on the floor)

Voice Over:
The Reverend Arthur Belling is Vicar of St Loony Up The Cream Bun and Jam. And now an appeal on behalf of the National Trust.

-T.J. Insane