Dr C Tetseo BDS,
GD-HP (Tobacco Control) & District Nodal Officer NTCP, Dimapur
The World Health Organisation has chosen ‘Tobacco and heart diseases’ as the theme for the World no Tobacco Day 2018, reflecting the increasing trend in the incidence of cardio vascular diseases attributing to tobacco use.
This is relevant for India because the Global burden of diseases study has reported that deaths as well as mortality from cardio vascular diseases have more than doubled in the last 30 years in India. The age-adjusted CVD mortality rate of 349/100000 population in men and 265/100000 in women is one of the highest in the world.
It is a fact that Tobacco is the second biggest preventable cause of Heart diseases after High blood pressure. It’s believed that nearly thirty percent of all heart disease deaths could be attributed to smoking and other tobacco uses. In India, tobacco is used in many forms like cigarette, bidi, hookah and tobacco chewing like khaini, zarda etc. and tobacco in all forms has been shown to be detrimental to cardiovascular system. Smoking affects the heart by multiple means. It contains high levels of carbon monoxide. Carbon monoxide affects the heart by reducing the amount of oxygen the blood is able to carry. This means that the heart, lungs, brain, and other vital organs do not always receive enough oxygen to perform everyday functions. At the same time, nicotine causes an increase in heart rate and blood pressure increasing the load on the heart in the long run. There are thousands of other harmful chemicals and free radicals in tobacco products which promote the deposition of fat in the wall of the arteries by damaging the cells lining the arteries and increasing the tendency for blood to clot. This is why people who smoke are more likely to have heart attacks, high blood pressure, blood clots, strokes, haemorrhages, aneurysms, and other disorders of the cardiovascular system.
So, it is well established that smoking is one of the biggest risk factors for heart diseases but smokeless tobacco has not been well studied in the past. The reason is that the prevalence of smokeless tobacco use is very low in the western countries and Europe.
Moreover, the ingredients used in gutka and Zarda in India is very different from what is normally used in the west. But of late, several studies have been carried out in India and now there is increasing evidence that smokeless tobacco plays an important role in cardio vascular diseases. The researches show that there is significantly greater prevalence of multiple cardiovascular risk factors - obesity, resting tachycardia, hypertension, high total and LDL cholesterol, and low HDL cholesterol, and electrocardiographic changes in tobacco users, chewing or smoking as compared to tobacco non-users. It is not surprising because most of the chemical ingredients in smoking products are also there in smokeless tobacco.
In fact, some studies show that diastolic BP was higher in tobacco chewers than smokers. This could be because of the sustained level of nicotine in the blood as chewing tobacco is kept in the mouth for a much longer time leading to grater absorption.
Moreover, sodium content in the gutkas always high as the factories are never regulated. So, tobacco use in any form should be a concern for all. GATS Survey 2016-17 shows that Nagaland has tobacco prevalence of 43% among adults and the prevalence of smokeless tobacco alone is 39%. Any society with high prevalence of tobacco use coupled with poor discipline of food habits spells doom for the health of the society.
It is a wakeup call for all the stake holders to realise the danger posed by tobacco and the need of the hour is the political will to strictly implement the Tobacco control laws in the state and at the same the Church and NGOs need to play a greater role on this in order to bring down the incidence of tobacco related diseases like heart diseases and cancer in our state.
