Billings Clinic


Tobacco dependence treatment and reducing your risk for cardiovascular disease and cancer

Posted at 12:50 PM, Nov 06, 2020

Tobacco dependence treatment and reducing your risk for cardiovascular disease and cancer

By Geoffrey C. Williams, MD, PhD

Medical Director of Collaborative Science & Innovation, Billings Clinic

So many things have changed for us in the past year with the spread of the COVID-19 pandemic. Keeping yourself safe from serious illness remains a top personal priority. Avoiding COVID-19 infection has rightly risen to the top of our health priorities, along with developing an effective vaccine and improved treatments for those unfortunate enough to come down with severe illness from this virus.

COVID-19 has affected us in many ways that are beyond just getting the virus. Stress levels are higher, people are distanced from their social networks, people are getting less physical activity, and we may not be getting our usual health care needs met. We also know that older patients and those with more cardiovascular risk suffer higher rates of severe COVID-19 illness. That means they are more likely to be hospitalized, need a ventilator and ICU care or die from the infection. With that in mind, maintaining or improving your cardiovascular health while a vaccine and effective treatments are developed is an important step you can take to keep yourself healthy. Modifiable major risk factors that raise your chances of having a heart attack or stroke, or dying from either, include any use of tobacco or vaping, untreated high blood pressure (above 130/90 is hypertension), having high LDL-Cholesterol (levels below 100 mg/dl are optimal- with lower being the best), or high triglycerides (> 150 mg/dl on a fasting sample). Eating a heart healthy diet, limiting alcohol to less than one drink per day and getting at least 30 minutes of walking per day can help reduce your cardiovascular risk quite dramatically.

Tobacco dependence treatments have been refined and widely tested for safety and effectiveness. These treatments are the subject of the 2020 Surgeon General’s Report on Tobacco. This report indicates that stopping smoking reduces your risk for heart attack or stroke by 50% within one year of stopping. This is a significant benefit and if you also lower your LDL cholesterol by 80 points with medication, your risk for heart attack or stroke is reduced by more than 60%. Eating a heart healthy diet like diet – for example, the Medeterranian diet, which includes whole grains, some nuts, less red meat, and five to eight half cup servings of fruits and vegetables combined – will lower your risk and improve your heart health even more.

Smoking suppresses your immune system. When you stop smoking, immune system function improves by up to 50% phrase within one year and back to normal within five years, your risk for diabetes reduces, damage to your lungs stops and your risk for lung and other cancers all begin decreasing. Smokers are three times more likely to get the flu or pneumonia than those that don’t smoke. Getting vaccines against the flu and the pneumococcal bacteria that causes many cases of pneumonia is ever more important in the time of COVID-19 to keep yourself healthy.

The Surgeon General’s Report also indicates that when smokers work with a tobacco dependence counselor or physician they are more than twice as likely to successfully stop smoking. Adding safe medications like varenicline (Chantix) or the nicotine patch can double to triple your success in stopping. Yet, most smokers try to stop on their own, but 95% of their quit attempt fail.

Through tobacco dependence counseling services at Billings Clinic, we ask that participants plan to make 6 to 8 visits (in person or via telehealth) in 6 months and to strongly consider using a medication to relieve the misery of nicotine withdrawal, which can include anxiety, irritability, trouble concentrating and cravings. The medications used to treat tobacco dependence are safe, make stopping much more comfortable. They have been shown to double (nicotine patches, Zyban) or triple (Chantix) quit rates 6 to 12 months after treatment and our program will recommend and prescribe these medications for those willing to use them.

In addition to treating the addiction with a medication, smokers need to change their patterns of smoking or e-cigarette use to break their habit. This could include delaying the first cigarette by 45 minutes after getting up and after meals, avoiding smoking with coffee or alcohol and change to a brand you don’t like. Pack-a-day smokers do much better if they start cutting down their cigarettes to less than 10 per day, and even better if they move below 5 before their quit day. Choose a stop date of 1-2 weeks after starting varenicline (Chantix) and after changing your smoking habits. Ask your friends, family and health care practitioner to be positive to you about your trying to stop. Equally important is to go easy on yourself - any reduction is positive and makes it easier to quit if you have to try again. This is often hard to do, but with continued effort anyone can stop and be relatively comfortable.

For details on tobacco cessation counseling and medication support, please feel free to call Billings Clinic at 406-435-8623 or visit We look forward to helping you stop smoking, vaping or chewing nicotine and tobacco. We will also work to optimize your cardiovascular health. We know these changes dramatically reduce your risk of cancers, getting diabetes, and having a stroke or heart attack.