Can one cigarette a day cause a heart attack or stroke?

Moderation is the key to long-term success, is a line I often use with my patients (and try and apply to my life too). However, there is one area, where moderation does not work, and that's for smoking. Most smokers accept that they have a problem, but are so addicted to the habit that, when I counsel them to quit, they will try and rationalize with me (and themselves) how a cigarette once in a while won’t hurt them. They also try to convince me that since they were smoking 15 cigarettes a day earlier, wouldn’t it be okay if they cut it down to five cigarettes a day. My answer to them is a well-rehearsed one, since I have said it a hundred times. I tell them, it’s like asking me whether it’s better to jump off the fifteenth floor of a building, or jump off the fifth floor! They usually get the message.

Last month, a study was published in the BMJ (British Medical Journal) which underscored this point. (Click here for study abstract). Researchers looked at studies from 1946 to 2015, and found that smoking one cigarette a day was associated with a 48% to 74%  increase in the risk of coronary heart disease (CHD) in men, a 57% to 119% increase in CHD risk for women, and a roughly 30% increase in the risk of stroke for both men and women.

The conclusions of the study, were:

Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders.

Benefits of quitting:

It’s never too late to quit smoking. It does not matter how long you’ve been smoking, the moment you quit your risk starts dropping. In fact, the benefits start from the minute you extinguish your last cigarette. Within the first hour your heart rate and blood pressure drop and the carbon monoxide level in your blood returns to normal. Over time your risk for heart attack, stroke and cancer starts dropping steadily towards that of a non-smoker. Of course, this information should not be used by you as a license to continue smoking with the thought that you will give it up one day in the future and recover all of your lost health. Remember, once there is build-up of plaque in your arteries, it can lead to a heart attack any time it ruptures. Smoking is one of the key factors that can precipitate plaque rupture, which is why even one cigarette can be harmful in the setting of blockages. It’s similar to standing on the edge of a cliff. Even a slight push may be enough to topple you over; in the same way, one cigarette may be the final straw that broke the camel’s back (no, not the cigarette brand, Camel).

Last para excerpted from my book, The Heart Truth