[Prevention of coronary heart disease: smoking].

摘要: Smoking is the leading preventable cause of illness and premature death in Germany, claiming over 110,000 lives a year because it directly increases risk dying from heart disease, stroke, emphysema variety cancers. The overwhelming majority smokers begin tobacco use before they reach adulthood. Among those young people who smoke, average age now 13-14. In about 39% male 31% female adults (age 18-60 years) continue to despite information unequivocally negative health consequences smoking. exact mechanisms smoking-related vascular disease are not yet known. causes acute hemodynamic alterations such as increase rate, systematic coronary resistance, myocardial contractility, oxygen demand. These short-term effects could lower ischemic threshold with artery contribute increased for cardiovascular events. Endothelial damage thought be an initiating event atherosclerosis early studies have demonstrated that long-term smoking has direct toxic structural changes human endothelial cells. Recent research shown importance functional role endothelium regulating tone, platelet-endothelial interactions, leukocyte adhesion smooth muscle cell proliferation via synthesis release substances nitric oxide. There strong evidence leads dysfunction mainly by inactivation oxide oxygen-derived free radicals. also oxidative modification LDL associated HDL plasma levels. induces systemic inflammatory response count elevation C-reactive protein level. Importantly, prothrombotic been repeatedly platelet function, imbalance antithrombotic vs factors, decrease fibrinolytic activity. Given enormous hazard use, complete abstinence should achieved. cessation counselling given healthy subjects even more vigorously patients manifested disease. Every effort undertaken prevent children adolescents starting smoke. Brief dependence treatment effective, every smoker offered at least brief office visit. More intensive effective producing tobacco. Nicotine replacement therapy (nicotine patches or gum), clinician-delivered social support, skills training three most components treatment. A framework control measures necessary reduce consumption exposure Recommendations on specific interventions are: 1. taxes; 2. comprehensive advertising bans; 3. legislation prohibiting work public places; 4. sales products persons under 18; 5. disclosure physical, chemical design characteristics all products; 6. professionals promote prevention interventions; 7. development national network services.