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Smoking is one of the leading causes of cardiovascular disease and CVD is responsible for more than 800 000 deaths per year in the US. Nicotine and carbon monoxide that are present in cigarettes cause the cells that line the blood vessel to become inflamed and swollen which narrows the blood vessel.

The following conditions can occur:

Atherosclerosis - fat, cholesterol and substances from smoking  build up plaque on the walls of the artery causing it to become more narrow and less flexible

Coronary Heart Disease - arteries that carry blood to the heart tissue are blocked and narrowed by plaque and can obstruct the tissue from receiving oxygenated blood

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Cholesterol helps your body to produce hormones, build new cells and insulate nerves. The liver is responsible to produce cholesterol but animal based food like milk, meat and eggs also contribute to cholesterol in the body. When there is too much cholesterol in the blood vessels it can cause atherosclerosis. There are two different types of cholesterol - Low-density lipoprotein (LDL) considered "bad" cholesterol and High-density lipoprotein (HDL) considered "good" cholesterol. LDL is the main source that is responsible for artery-clogging plaque.

Maintaining good cholesterol levels:

Diet - Reduce the amount of trans fats, saturated fats and sugars to lower the blood cholesterol level. Eat more plant derived sterols and fiber to help lower LDL cholesterol

Weight & Exercise - Losing weight when overweight can help lower LDL cholesterol levels and increase HDL levels

Medical conditions - Hypothyroidism, liver and kidney disease can sometimes cause elevation of cholesterol levels in blood

Medications - Medicines like, steroids and progestins can cause increase in "bad" cholesterol and decrease in "good" cholesterol

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The narrowing and constriction of blood vessels along with thickening and stiffening of heart walls that are caused by high blood pressure is the main cause (non cardiac) of heart failure.

High blood pressure increases the heart's workload - the heart has to work harder when narrow arteries make it difficult for blood to flow through. The heart is going to work harder to ensure blood reaches all parts of the body

At some point a higher workload will lead to an enlarged heart - the heart wall thickens and expands to keep up with the demand which makes it less efficient

Different ways to control high blood pressure:

Exercise & eat healthy - exercise can help avoid the development of hypertension and eating whole grain, fruits, vegetables and low-fat dairy products can lower blood pressure up to 11 mm Hg

Reduce sodium in diet - decreased level of sodium can improve heart health and and reduce blood pressure by 5 to 6 mmHg. Make sure to read food labels, eat less processed food and don't add extra salt

Limit the amount of alcohol you drink - drinking too much alcohol can raise blood pressure while also reducing the effectiveness of blood pressure medications

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Obesity does not only increase "bad" cholesterol levels but also decrease "good" cholesterol levels. That is why it is important to have a healthy diet and exercise regularly. It can also cause your blood pressure to rise and as previously mentioned, high blood pressure contributes to heart disease. Obese people require more blood to supply their body with oxygen and nutrients which cause the raise in blood pressure. Obesity can lead to diabetes mellitus and people with diabetes are 2-4 times more likely to get heart disease.

Obesity is caused by the following:

- Intake of unhealthy calories/ poor diet
- Lack of physical activity
- Genetics

There are some rare genetic conditions that can cause obesity like Prader-Willi syndrome

- Medical reasons

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Diabetes can damage blood vessels and the nerves that control the heart.

Cardiovascular autonomic neuropathy (CAN):

Diabetes causes CAN which is damage to the autonomic nerve fibers that stimulates the heart and blood vessels which result in abnormal heart rate and vascular dynamic. Diabetic CAN is present in one fourth of type 1 diabetes and one third of type 2 diabetes. CAN is associated with increased mortality, silent myocardial ischemia and can predict the development of stroke.

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There are a few ways that exercise can directly and indirectly impact heart health:

Exercise lowers blood pressure - as previously mentioned, maintaining normal blood pressure is important for heart health. Exercise work like beta blocker medicine to slow down the heart rate and lower blood pressure.

Exercise is important to control weight - previously discussed that obesity and being overweight has a direct correlation with heart disease.

Exercise helps to strengthen muscle - to ensure heart health a person has to combine aerobic workouts (running, swimming, walking) and strength training (lifting weights, resistance training). This will make it possible for muscle to draw more oxygen from the blood stream.

Exercise can help you quit smoking - As a smoker becomes more fit, they tend to quit smoking.

Exercise can lower stress levels - Stress can put extra burden on the heart and cause bad health. Combining a variety of workouts can reduce stress and help you relax.

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Up to 80% of premature heart disease can be avoided by habits which include - eating healthy

Vegetables and fruits - Vegetables and fruits are packed with nutrients, aim for 7-10 servings daily

Whole grain foods - Whole grain foods have vitamin B, fiber and protein to help you stay healthy and maintain a healthy weight

Protein - Eat protein daily, it's important to build muscle

Processed foods - eat less ultra-processed foods to maintain a healthy diet

A few tips are to eat at home, make healthier choices at the grocery store and eat healthy snacks

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Different ways to manage stress and help your heart:

Stay positive - people with heart disease who maintain a positive attitude is less like to die of heart disease than people with a negative attitude, according to research

Meditate - the practice of deep breathing and inward-focused thought has proven to reduce different factors of heart disease like high blood pressure

Unplug - it's impossible to avoid stress when it follows you everywhere, make sure to actively cut yourself off from your phone and the TV even if it's just a short period of time

Find your own way of relieving stress - use any technique that works for you, everyone is different and make sure not to just copy someone. What works for one person might not work for another

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2) How tobacco affects the heart and blood vessels. How Tobacco Affects the Heart and Blood Vessels | Abiomed.com. (n.d.). Retrieved March 24, 2022, from https://www.abiomed.com/patients-and-caregivers/blog/how-tobacco-affects-the-heart-and-blood-vessels

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5) Mayo Foundation for Medical Education and Research. (2021, February 24). 10 drug-free ways to control high blood pressure. Mayo Clinic. Retrieved March 24, 2022, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974

6) Three ways obesity contributes to heart disease. Penn Medicine. (n.d.). Retrieved March 24, 2022, from https://www.pennmedicine.org/updates/blogs/metabolic-and-bariatric-surgery-blog/2019/march/obesity-and-heart-disease

7) NHS. (n.d.). NHS choices. Retrieved March 24, 2022, from https://www.nhs.uk/conditions/obesity/causes/

8) Centers for Disease Control and Prevention. (2021, May 7). Diabetes and your heart. Centers for Disease Control and Prevention. Retrieved March 24, 2022, from https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html#:~:text=Over%20time%2C%20high%20blood%20sugar,and%20can%20damage%20artery%20walls.

9) Vinik, A. I., Aaron I. Vinik From the Strelitz Diabetes Research Institute, Ziegler, D., Dan Ziegler From the Strelitz Diabetes Research Institute, & Vinik, C. to A. I. (2007, January 23). Diabetic cardiovascular autonomic neuropathy. Circulation. Retrieved March 24, 2022, from https://www.ahajournals.org/doi/10.1161/circulationaha.106.634949#d3e1023

10) 7 heart benefits of exercise. Johns Hopkins Medicine. (n.d.). Retrieved March 27, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/7-heart-benefits-of-exercise

11) Healthy eating. Heart and Stroke Foundation of Canada. (n.d.). Retrieved March 27, 2022, from https://www.heartandstroke.ca/healthy-living/healthy-eating

12) Stress and your heart. Harvard Health. (2013, December 1). Retrieved March 27, 2022, from https://www.health.harvard.edu/heart-health/stress-and-your-heart#:~:text=People%20with%20heart%20disease%20who,increase%20%22good%22%20HDL%20cholesterol.