Ask the Doctors May 2017 Issue

Ask the Doctors: May 2017

After more than 20 years I finally quit smoking a year ago. I know I feel better, but can any of the damage that smoking did to my heart or blood vessels ever be undone?

Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

Smoking harms nearly every organ, particularly the heart, blood vessels and lungs. It is the leading cause of preventable deaths from cancer (including lung, mouth, esophagus, bladder and pancreas), followed closely by deaths from heart disease and other diseases of the lungs. The simple answer to your question is yes. But the more you smoke the greater the possibility of permanent damage to your organs. Although the damage may not be completely reversed, stopping at any age can at least partially reverse this damage and improve life expectancy. Quit by age 30 and the risk of smoking-related diseases drops by 90 percent; by age 50 it drops by over 50 percent. But discontinuing at any age will add years to your life. The idea that “it’s too late now to make a difference” is a myth.

Within hours of quitting, heart rate and blood pressure improve and carbon dioxide levels drop. In weeks to months, cough and phlegm production lessen and circulation, taste, smell and lung function improve. In one year after quitting, the elevated risk of heart attack and stroke is cut in half. Smoking also increases the thickness and stiffness of the heart walls, which may reverse with smoking cessation. At five to 10 years, cancer risk is cut in half and approaches that of non-smokers by 15 years. In addition, when you quit you will notice improvement in your skin and breath. Also, the risk of developing cataracts, macular degeneration, osteoporosis, hearing loss and dementia drops.

If you smoke, there is a compelling reason to quit no matter how much or how long you have smoked. Expect an increase in life expectancy as well as improved health, finances, self-esteem, appearance and everyday life.

I have type 2 diabetes treated with metformin and a history of a coronary stent. I have recently heard that there are newer diabetes medications that may reduce the risk of future heart disease. Should I be taking these?

Diabetes itself is clearly associated with an increased risk of developing cardiovascular disease. That is why if you have diabetes you should work with your doctor to aggressively treat high blood pressure, use statin therapy for elevated cholesterol and take low-dose aspirin. Treating the elevated blood sugar of diabetes is also important to help prevent heart disease as well as kidney and eye disorders or neuropathy.

But are the medications used to lower blood sugar able to harm or help the heart? In the past, it was recognized that some drugs for diabetes management were associated with increased risk of heart failure and other heart disease. This prompted the FDA in 2008 to require that all new drugs for diabetes treatment be tested in clinical trials to make sure that there were no deleterious cardiovascular effects. Since the initiation of this process, some examined medications such as saxagliptin (known as a DPP-4 inhibitor) have been shown to increase the likelihood of heart failure and others such as liraglutide (a GLP-1 receptor agonist) and empagliflozin (a SGLT2 inhibitor) appear to be superior to a placebo at preventing cardiovascular events and related death.

Choosing the appropriate medications for management of your diabetes is a complex process that must take into account the extent and duration of the diabetes, current response to medications, kidney function, age, prior history of heart disease or heart failure. Joint discussions with your primary care doctor, endocrinologist and cardiologist are the best way to determine whether any of these newer medications would be right for you and reduce future heart events.

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