Although lighting up occasionally in social settings is perceived as less dangerous than smoking every day, US research shows the cardiovascular risks are the same.
The study of almost 40,000 people found no significant difference in hypertension and high cholesterol between social smokers and daily smokers, confirming that there is no level of smoking that is safe in terms of heart disease.
After adjusting for demographics and other factors, 54.6% of smokers and 53.3% of social smokers had high cholesterol, while 75.5% of smokers and 74.6% of social smokers had hypertension.
Social smokers and smokers were around twice as likely to have hypertension and 1.5 times as likely to have high cholesterol than non-smokers.
The findings dealt a blow to the wishful thinking social smokers, who often believed they were immune to the harmful effects of nicotine, the authors said.
“Clinicians need to educate patients that social smoking is still a major cardiovascular health risk, and should not be presented to patients as a long-term healthy choice when contemplating smoking cessation,” they wrote.
“Complete cessation is the only known modality that can reduce the risk of cardiovascular and cancer morbidity and mortality.”
Professor Garry Jennings, cardiologist and chief medical adviser at the Heart Foundation, said the study provided further justification for public health campaigns to eliminate smoking entirely.
“What this suggests is that there is really no level of smoking tobacco that isn’t associated with … risk factors for heart disease like hypertension and abnormal blood fats,” he said.
While it was likely that a dose-response relationship between smoking and negative health outcomes existed, no level of smoking was associated with normal health, he said.
“And, of course, there’s a lot of evidence that passive smoking is also harmful.”
Around 10% of study participants said they smoked socially, which was defined as smoking regularly in certain social situations, but not every day. An additional 17% identified as daily smokers.
What this suggests is that there is really no level of smoking tobacco that isn’t associated with … risk.
In Australia, around 13% of adults smoke daily, and 1% smoke weekly, while 2% smoke less often than weekly, Tobacco in Australia’s 2015 statistics show.
Smoking has hit historic lows Australia-wide, but smoking rates are still as high as 27% in the most socially disadvantaged areas.
Despite the risks associated with social smoking, this group was often overlooked in primary care, the authors said.
“When providing cardiovascular disease assessments, healthcare providers need to be reframing the way they ask about tobacco use,” they said.
“Questions such as ‘Are you a smoker?’ or ‘Do you smoke?’ should be avoided.
“Questions that also capture the social-smoking population should be encouraged such as ‘Do you ever smoke cigarettes or use tobacco in social situations such as at bars, parties, work events, or family gatherings?’”
American Journal of Health Promotion 2017, May 2