In 1964, the Surgeon General of the United States released the first report on smoking and health. The report stated that cigarette smoking was:

• A cause of lung and laryngeal cancer in men

• A probable cause of lung cancer in women

• The most important cause of chronic bronchitis

We also know that cigarette smoking is a risk factor for cardiovascular disease.

In 1969, the U.S. Congress adopted the Public Health Cigarette Smoking Act, which required a health warning on cigarette packages and banned cigarette advertising on broadcast media.

In the 1960s, about 40 percent of Americans smoked cigarettes. By the 1980s, 32 percent of Americans smoked. The decline correlates with the declining rate of deaths from heart disease that began in the 1970s.

It is well-known that cigarette smoking is related to an increased homocysteine level.

For instance, a study in the European Heart Journal found that cigarette smoking was associated with increased plasma homocysteine level.

The study authors wrote, “Both [increased homocysteine and cigarette smoking] are associated with cardiovascular disease.”

The scientists reported that compared to control subjects who did not smoke and had normal homocysteine levels, cigarette smokers had more than 12 times the risk of cardiovascular disease.

In all groups studied, cigarette smokers had higher homocysteine levels than nonsmokers.

Cigarette smoking also elevates the risk for heart disease by increasing inflammation in blood vessels. Homocysteine is thought to cause heart disease by a similar increase in blood vessel inflammation.

There is no question that cigarettes are a direct cause of increased heart disease risk.