Quit smoking for you – and your children

No conscientious parent ever wants to pass down a health risk to their children. But, while it’s impossible to control passing down genetic disorders like Huntington’s disease or the BRCA gene, there is one important health risk parents can control.

“Just don’t smoke in front of the kids,” said Cardiologist Peter Chiotellis, MD, FACC, at the Heart Center in Hyannis.

That advice comes on the tail of a new study published in the Journal of the American College of Cardiology. The study showed that children exposed to secondhand smoke had a significantly increased risk of developing atrial fibrillation, a potentially life-threatening heart condition, later in life.

The study used data from the Framingham Heart Study and the Framingham Heart Offspring Studies. Close to 3,000 of the children in the Offspring study had parental smoking status available. Of those children, 82 percent had been exposed to secondhand smoke. Over a follow-up period of 40.5 years, 14.3 percent developed atrial fibrillation (AFib). Each pack-per-day increase in parental smoking increased the chance of developing AFib by 18 percent. 

When Dr. Chiotellis explains what AFib is to his patients, he asks them to picture their heart like a house with rooms, doors, plumbing and electrical wiring. AFib is a problem with the electrical wiring of the heart. In a healthy heart, a heartbeat originates in the atria and then travels through the rest of the heart causing a synchronized contraction. With atrial fibrillation, instead of just one heartbeat firing off, multiple ones do, causing a chaotic motion that prevents the heart from beating normally. Instead of beating, it fibrillates.

“What we worry about in atrial fibrillation is that because there are a lot of different heartbeats coming down at once, your heart rate can go really fast,” Dr. Chiotellis said. “Also, if that small chamber of the heart isn’t properly squeezing, blood flow can become stagnant. The blood can pool and if blood pools, it can clot. The clot can break off and it can leave the heart and go up through the carotid arteries and cause a stroke. Or it can move to other parts to occlude blood vessels.”

In the past, the dangers of secondhand smoke – and of smoking, in general – were not well understood.

“We do know now that passive smoke exposure is bad for you, which we didn’t know generations ago,” Dr. Chiotellis said. “Doctors used to smoke in hospitals and people smoked on airplanes.”

It wasn’t until 1986, that U.S. Surgeon General C. Everett Koop concluded that secondhand smoke was a major health risk to those who don’t smoke. Now secondhand smoke is known to cause the following health problems in children according to the CDC:

• More frequent and severe asthma attacks
• Respiratory infections
• Impaired lung function
• Ear infections
• Sudden infant death syndrome

In the adult population, the CDC stats show that non-smokers who are exposed to secondhand smoke at home or at work increase their risk of developing heart disease by 25 to 30 percent. Since that is the case, it only makes sense that secondhand smoke would also increase risk for children who are exposed to it.

But Dr. Chiotellis points to an even bigger risk factor when parents smoke.

“Kids mimic their parents’ behavior,” he said. “If you smoke, your kids are more likely to smoke, so I think the bigger picture is that we know that smoking increases your risk of atrial fibrillation. I looked at some other studies that showed that compared to non-smokers, smokers had a higher incidence of atrial fibrillation and people who quit smoking had a lower rate than current smokers as well. It’s never too late to quit.”

AFib Treatment

AFib is one of the most common arrythmias that cardiologists see as people get older, Dr. Chiotellis said. Aside from age, other risk factors include:

• High blood pressure
• Smoking
• Excessive alcohol use
• A family history of AFib
• An overactive thyroid
• Untreated sleep apnea
• And now exposure to secondhand smoke

The first line of defense to treat AFib is to prescribe a blood thinning medication like Xarelto, Eliquis or Pradaxa. Cardiologists also do a procedure called cardioversion, where the patient is sedated and the heart is shocked back to normal sinus rhythm. It’s an outpatient procedure done at the hospital.

“Cardioversion is a very common procedure in the cardiac world,” Dr. Chiotellis said. “It’s kind of like hitting the reset button in that small chamber to get rid of all those different other heartbeats firing all at once.”

The success rate of cardioversion is high, but the longer you are in atrial fibrillation, the harder it is to get you out of it because the heart gets used to it. If the cardioversion is not successful and patients are very symptomatic, they can be put on antiarrhythmic drug therapy that can help keep them out of AFib and increase the effectiveness of the cardioversion.

The final solution is to do a heart ablation, during which a cardiologist inserts a catheter and guides it to the patient’s heart. Once there, using an ultrasound, the doctor will zap the spots in the heart that are causing trouble. Patients are sedated during this procedure and usually stay in the hospital overnight.

“Ablations can be more of a curative approach,” Dr. Chiotellis said. “They can eventually help reduce your medication burden as well. They are involved procedures, but for people who really feel their AFib, they are really great.”

Even though effective treatments are available, a better outcome would be to not develop AFib in the first place. You can increase your chances (and your children’s) greatly by living a heart-healthy lifestyle that includes a diet rich in plants, regular exercise and refraining from drinking too much or smoking cigarettes. That’s behavior that every parent should want their child to model, and it starts with you.

If you are interested in quitting smoking, talk to your doctor about safe nicotine replacements like gum, lozenges, patches and prescription drugs that can quell the urge to smoke. You can also visit smokefree.gov.

They offer a quit plan, tips on the best ways to quit and smoke-free apps and text messaging that offers 24/7 support and encouragement. They also offer the chance to speak with experienced smoking cessation counselors who will help you make a plan to succeed if you call 1-800-QUIT-NOW. You can even sign up to participate in a research study that might help other people quit in the future.