Tobacco Kills

A Call to Industry

Tobacco use is the common denominator in 40% of all cardiovascular disease cases (1) and accounts for 480,000 deaths each year as the leading cause of preventable death in the United States (2). Not surprisingly, the life expectancy of smokers is 10 years shorter than for nonsmokers (3). However, even nonusers are affected. Secondhand smoke, which contains a mixture of 7,000 chemicals, causes nearly 34,000 deaths annually from heart disease (4). As leaders in the health care industry, we are acutely aware of these alarming statistics and are calling on our colleagues and partners in our field to stand together and put an end to tobacco use in America.

Efforts to end tobacco use in America have certainly made strides in the last 5 decades, as the percentage of American adults that smoke has dropped by 57% (from 42% in 1964 to 18% today) since the 1960s, when the Surgeon General first issued a warning about cigarette use and the Federal Trade Commission mandated prominent warnings on cigarette packages and cigarette advertisements (1).

At the state level, legislation has helped play into this decline as a growing number of states have implemented 100% smoke-free laws in nonhospitality workplaces, restaurants, and bars, and many others have smoke-free legislation pending or partial smoke-free laws already in place. There are only a handful of states that have not engaged in state-wide smoke-free legislation—Alabama, Alaska, Kentucky, Mississippi, Missouri, Oklahoma, South Carolina, Texas, West Virginia, and Wyoming—and we look to them to take a stand as well. Additionally, the American College of Cardiology (ACC) just this year has worked closely with the Campaign for Tobacco Free Kids to urge the Food and Drug Administration to further regulate tobacco products, including e-cigarettes.

Unfortunately, despite increased taxation on tobacco products and smoke-free legislation, cigarettes are still used by more than 42 million adult Americans (2), and the burden on health care systems is heavy. Annual smoking-attributable economic costs in the United States between just 2009 and 2012 reached more than $289 billion (4). This year, on the 50th anniversary of a Surgeon General’s report commissioned by then President John F. Kennedy, the Office of the Surgeon General released a report highlighting a number of obstacles still plaguing public health, including the burden of death and disease from tobacco use. The report states that rapid elimination of tobacco use will dramatically reduce this burden (4).

CVS Health is boldly answering this call by pulling tobacco products off its shelves (5). As of October 1, 2014, all 7,600 CVS pharmacy stores across the United States are no longer selling tobacco products. In addition, the company has created a national onsite and digital comprehensive smoking cessation program as part of its commitment to putting customers on the path to better health. This shows the commitment that CVS Health has made to put the health of its customers above the profits of the organization. We hope this inspires other major retail pharmacies like Walgreens, Walmart, Rite Aid, and others to hopefully follow that philosophy.

If we are serious about improving public health and reducing the skyrocketing health care costs associated with treatment of chronic disease, it is important that we get behind companies like CVS Health and work together in ways we have not before.

As part of its 5-year strategic plan centered on the “triple aim” of better care, better outcomes, and lower cost, the ACC is committed to public health and improving the health of populations. The College is committed to developing partnerships with organizations and other stakeholder groups, like CVS Health, to pursue national and international population health objectives related to cardiovascular disease health. The ACC is also supporting its members in their expanded accountability to improve the health of populations and encouraging cardiovascular team-facilitated patient education on topics like smoking cessation.

Focusing on prevention is a key component of the ACC’s commitment to population health, and the College is doing so by arming cardiovascular professionals with point-of-care tools and resources to share with their patients—particularly via ACC’s CardioSmart program. The College’s Prevention Committee is ACC’s direct member connection to programming and resources surrounding the prevention of cardiovascular disease, and is a key player in driving the College’s strategies. The ACC’s partnership with the Million Hearts initiative, which has set out to prevent 1 million cardiovascular events by 2017, is focused on improving management of 4 cardiovascular disease indicators, 1 of which is smoking cessation. Additionally, the ACC is part of the Non-Communicable Diseases (NCD) Alliance, a global task force that emerged in response to a May 2012 declaration by the United Nations to reduce premature death caused by noncommunicable diseases by 25% by the year 2025. The NCD Alliance has established risk factor reduction targets, including a 30% relative reduction in the prevalence of tobacco smoking (6).

Partnerships are key as we work to tackle the lingering tobacco use problem in America. Pharmacies should join CVS Health in pulling tobacco products from their shelves. The ACC welcomes the continued or expanded partnership with like-minded health care organizations who continue to advocate for tobacco-free legislation, help arm cardiovascular professionals with tools to talk with their patients about tobacco use, and direct tools and resources for patients around prevention or how to quit. Together, we can make tobacco use an anachronism. We look forward to the day when cardiovascular mortality and tobacco use no longer correlate at such a high rate in America.

• American College of Cardiology Foundation