Smoking increases the risk of heart disease and stroke by five-fold in people under the age of 50 and doubles risk in the over-60s. The protection of children and adolescents from taking up smoking is essential to the future health of Europeans and stronger measures are needed, according to the European Society of Cardiology (ESC). The warning comes on World No Tobacco Day, held today.

Cardiovascular disease (CVD) is the number one killer in Europe and is responsible for the death of 1.9 million EU citizens every year. Smoking causes 28% of CVD deaths in men aged 35 to 69 years and 13% of CVD deaths in women of the same age.2 Risks from smoking are related to how much tobacco is smoked daily and to how long a person has been a smoker.

Professor Grethe Tell, ESC prevention spokesperson, said: “We know that the earlier one starts smoking, the more damage the smoke does. One reason is that there is a dose response relationship between how many years one smokes and the risk of cardiovascular disease, so the younger you are when you start, the higher dose you get altogether. In addition, the earlier you start smoking, the more addicted you may become and therefore the more difficult it will be to stop smoking later.”

The ESC is also calling for a number of measures to prevent young people from taking up smoking including the following

• Ban tobacco products with a characterising flavour from the market. Flavours improve the taste and make it easier to inhale, particularly for young people just starting to smoke
• Introduce plain packaging for tobacco products and avoid trademarks or promotional elements. Studies suggest that this will have a large impact on preventing young adults from trying smoking
• Cover at least 75% of the front and back packaging with health warnings on the multiple risks of smoking. These warnings are particularly effective with young adults
• Enforce age verification by retailers, with large financial penalties for underage sales.
• Introduce a requirement for medicine authorisation of all non-tobacco nicotine containing products to prevent promotion to young adults who are non-smokers
• Regulate electronic cigarettes as a tobacco and medical product. Brands with flavours such as vanilla or chocolate attract children and put them at increased risk of experimenting with cigarettes or other nicotine containing products

European health institutions are currently working on a new “Tobacco Products Directive”. The ESC is therefore calling the relevant policy-makers to include its recommendations and adopt optimal public health protection measures.

Stopping young people taking up smoking is a key goal of the ESC joint guidelines on prevention of cardiovascular disease. Other recommendations are to avoid smoking and exposure to passive smoking, and that all smokers should be given advice and help to quit.

Passive smoking at home or in the work place increases the risk of CVD by 30%. However, smoking bans lead to rapid and sizeable reductions in hospitalizations for acute myocardial infarction. People who stop smoking also rapidly reduce their risk of CVD.

Professor Tell said:“Passive smoking is much more dangerous than many people think. Increasing exposure to cigarette smoke, either active or passive, is significantly associated with atherosclerosis.’’

She concluded:“Prevention of smoking is the most cost-effective way to treat and prevent cardiovascular disease. This is particularly important for children and adolescents who are susceptible to tobacco promotion and find it more difficult to quit smoking.”