Smoking and Cardiovascular Health with Herbal Treatment

Abstract

This article provides a comprehensive review of the impact of smoking on cardiovascular health, highlighting the epidemiology, pathophysiological mechanisms, and associated risks, including atherosclerosis, endothelial dysfunction, and a prothrombotic state. The review synthesizes extensive research demonstrating that both active and passive exposure to cigarette smoke significantly elevate the risk of various cardiovascular diseases, principally through inflammatory, oxidative, and thrombotic pathways, and by unfavorably altering lipid profiles. Additionally, the article explores the potential benefits of herbal interventions—such as Moringa oleifera, Ginseng, and Ginkgo biloba—in reducing cardiovascular risk factors and improving patient outcomes, attributing their efficacy to multi-target anti-inflammatory, antioxidant, and lipid lowering properties. The article concludes that while traditional cessation strategies have reduced global smoking rates, integrating herbal therapies with established treatments could enhance cardiovascular prevention, though further rigorous clinical trials are warranted to confirm their long-term safety and efficacy.

Introduction

Cardiovascular diseases (CVDs) are a leading global cause of morbidity and mortality, imposing a substantial economic burden—nearly $200 billion annually in the US. Smoking is a major modifiable risk factor, contributing to coronary artery disease, peripheral arterial disease, cerebrovascular disease, aneurysms, arrhythmias, heart failure, and increased mortality. Active and passive smoking exposes individuals to harmful substances such as nicotine, tar, carbon monoxide, formaldehyde, and heavy metals, which induce oxidative stress, inflammation, endothelial dysfunction, and lipid profile alterations.

Epidemiology & Risk Factors:

• CVD prevalence rises with age, varies by gender, and is influenced by family history.

• Women with diabetes or heavy smoking habits have a higher relative risk than men.

• Costs of CVD are projected to rise from $237 billion (current) to $368 billion by 2035.

Pathophysiology:

1. Endothelial Dysfunction: Smoking damages vascular walls, decreases nitric oxide, and impairs vasodilation.

2. Lipid Profile Impact: Smokers have higher LDL, VLDL, triglycerides, and lower HDL, promoting atherogenesis.

3. Inflammation: Smoking elevates inflammatory markers (leukocytes, CRP, IL-6, TNF), contributing to plaque formation.

4. Prothrombotic State: Smoking increases fibrinogen, platelet aggregation, tissue factor expression, and impairs fibrinolysis, enhancing clot formation.

Signs & Symptoms:

• Chest pain, dyspnea, fatigue, dizziness, swelling in extremities.

• Often asymptomatic until severe events (heart attack, stroke) occur.

• Symptom presentation can vary by gender, cognitive function, and comorbidities.

Herbal Interventions & Cardioprotective Effects:

• Moringa oleifera: Anti-apoptotic, antioxidant, anti-inflammatory; improves cardiac contractility and vascular protection.

• Turmeric (Curcuma longa): Anti-inflammatory, cardiovascular and anti-aging benefits, interacts positively with gut microbiota.

• Ginseng: Enhances myocardial contractility, vasodilation, anti-inflammatory, antioxidant, and anti-apoptotic effects. Bioactive ginsenosides (Rg3, Rh2, Rb3) improve cardiac function, reduce fibrosis, and mitigate ischemia/reperfusion injury.

Conclusion

Smoking is a major risk factor for cardiovascular diseases, causing damage primarily through inflammation, oxidative stress, and blood clotting pathways. While smoking rates have declined, the cardiovascular burden remains significant. Herbal treatments like Moringa, Ginseng, and Ginkgo show promise in reducing cardiovascular risks through multiple mechanisms, but more clinical trials are needed to confirm their long-term safety and effectiveness. Combining herbal therapies with conventional treatments could improve cardiovascular outcomes for smokers.

References

[1] Gallucci, G., Tartarone, A., Lerose, R., Lalinga, A. V., & Capobianco, A. M. (2020). Cardiovascular risk of smoking and benefits of smoking cessation. Journal of Thoracic Disease, 12(7), 3866–3876. https://doi.org/10.21037/jtd.2020.02.47 [2] Alhindal, M., Janahi, J., D\'Angelo, E. C., Lisignoli, V., Palmieri, R., Cutrì, A., Butera, G., Gatzoulis, M. A., & Montanaro, C. (2025). Impact of smoking on cardiovascular health: Mechanisms, epidemiology and specific concerns regarding congenital heart disease. International Journal of Cardiology Congenital Heart Disease, 20, Article 100581. https://doi.org/10.1016/j.ijcchd.2025.100581 [3] Rahman, M., Alatiqi, M., Al Jarallah, M., Hussain, M. Y., Monayem, A., Panduranga, P., & Rajan, R. (2025). Cardiovascular effects of smoking and smoking cessation. Global Heart, 20(1). https://doi.org/10.5334/gh.1399 [4] Parmar, M. P., Kaur, M., Bhavanam, S., Mulaka, G. S. R., Ishfaq, L., Vempati, R., Faseel C, M., Kandepi, H. V., Rajagopal, E. R., Sahu, S., & Divulge, S. (2023). A systematic review of the effects of smoking on the cardiovascular system and general health. Cureus, 15(4), e38073. https://doi.org/10.7759/cureus.38073 [5] Cho, J. H., Shin, S. Y., & Kim, H. (2024). Smoking cessation and incident cardiovascular disease. JAMA Network Open, 7(4), Article e2442639. https://doi.org/10.1001/jamanetworkopen.2024.42639 [6] Fox, C. S., Coady, S., Sorlie, P. D., Levy, D., Meigs, J. B., D’Agostino, R. B., Wilson, P. W., & Savage, P. J. (2004). Trends in cardiovascular complications of diabetes. JAMA, 292(20), 2495–2499. https://doi.org/10.1001/jama.292.20.2495 [7] Fox, C. S., Pencina, M. J., Wilson, P. W., Paynter, N. P., Vasan, R. S., & D’Agostino, R. B. (2008). Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham Heart Study. Diabetes Care, 31(8), 1582–1584. https://doi.org/10.2337/dc08-0025 [8] Dunbar, S. B., Khavjou, O. A., Bakas, T., Hunt, G., Kirch, R. A., Leib, A. R., Morrison, R. S., Poehler, D. C., Roger, V. L., & Whitsel, L. P. (2018). Projected costs of informal caregiving for cardiovascular disease: 2015 to 2035: A policy statement from the American Heart Association. Circulation, 137(19), e558–e577. https://doi.org/10.1161/CIR.0000000000000570 [9] Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., de Ferranti, S. D., Ferguson, J. F., Fornage, M., Gillespie, C., Isasi, C. R., Jiménez, M. C., Jordan, L. C., Judd, S. E., ... Muntner, P. (2018). Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation, 137(12), e67–e492. https://doi.org/10.1161/CIR.0000000000000558 [10] Arsenault, B. J., Boekholdt, S. M., & Kastelein, J. J. P. (2011). Lipid parameters for measuring risk of cardiovascular disease. Nature Reviews Cardiology, 8(4), 197–206. https://doi.org/10.1038/nrcardio.2010.223 [11] Salahuddin, S., Prabhakaran, D., & Roy, A. (2012). Pathophysiological mechanisms of tobacco-related CVD. Global Heart, 7(2), 113–120. https://doi.org/10.1016/j.gheart.2012.05.003 [12] Mahady, G. B. (2002). Ginkgo biloba for the prevention and treatment of cardiovascular disease: A review of the literature. Journal of Cardiovascular Nursing, 16(4), 21–32. [13] Olvera Lopez, E., Ballard, B. D., & Jan, A. (2023). Cardiovascular disease. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535419/ [14] Mahady, G. B. (2002). Ginkgo biloba for the prevention and treatment of cardiovascular disease: A review of the literature. Journal of Cardiovascular Nursing, 16(4), 21–32. [15] Shu, Z., Sha, A. H., Shahen, M., Wang, H., Alagawany, M., Abd El-Hack, M. E., ... Shar, P. A. (2019). Pharmacological uses of Ginkgo biloba extracts for cardiovascular disease and coronary heart diseases. International Journal of Pharmacology, 15(1), 1–9. https://doi.org/10.3923/ijp.2019.1.9 [16] Shaito, A., Thuan, D. T. B., Phu, H. T., Nguyen, T. H. D., Hasan, H., Halabi, S., Abdelhady, S., Nasrallah, G. K., Eid, A. H., & Pintus, G. (2020). Herbal medicine for cardiovascular diseases: Efficacy, mechanisms, and safety. Frontiers in Pharmacology, 11, Article 422. https://doi.org/10.3389/fphar.2020.00422 [17] Abu Hajleh, M. N., & Al-Dujaili, E. A. S. (2023). Effects of turmeric concentrate on cardiovascular risk factors and exercise-induced oxidative stress in healthy volunteers: An exploratory study. Advanced Pharmaceutical Bulletin, 13(3), 601–610. https://doi.org/10.34172/apb.2023.052 [18] Karmazyn, M., Moey, M., & Gan, X. T. (2011). Therapeutic potential of ginseng in the management of cardiovascular disorders. Drugs, 71(15), 1989–2008. https://doi.org/10.2165/11593800-000000000-00000 [19] Lee, C. H., & Kim, J. H. (2014). A review on the medicinal potentials of ginseng and ginsenosides on cardiovascular diseases. Journal of Ginseng Research, 38(3), 161–166. https://doi.org/10.1016/j.jgr.2014.04.003 [20] Buettner, C., Yeh, G. Y., Phillips, R. S., Mittleman, M. A., & Kaptchuk, T. J. (2006). Systematic review of the effects of ginseng on cardiovascular risk factors. Annals of Pharmacotherapy, 40(1), 83–95. https://doi.org/10.1345/aph.1G218 [21] Wal, A., Verma, N., Balakrishnan, S. K., Gahlot, V., Dwivedi, S., Sahu, P. K., Tabish, M., & Wal, P. (2024). A systematic review of herbal interventions for the management of cardiovascular diseases. Current Cardiology Reviews, 20(5), 31–42. https://doi.org/10.2174/011573403X286573240422104647 [22] Mallah, M. A., Soomro, T., Ali, M., Noreen, S., Khatoon, N., Kafle, A., Feng, F., Wang, W., Naveed, M., & Zhang, Q. (2023). Cigarette smoking and air pollution exposure and their effects on cardiovascular diseases. Frontiers in Public Health, 11, Article 967047. https://doi.org/10.3389/fpubh.2023.967047 [23] Arsenault, B. J., Boekholdt, S. M., & Kastelein, J. J. P. (2011). Lipid parameters for measuring risk of cardiovascular disease. Nature Reviews Cardiology, 8(4), 197–206. https://doi.org/10.1038/nrcardio.2010.223 [24] Louisa, M., Patintingan, C. G. H., & Wardhani, B. W. K. (2022). Moringa oleifera Lam. in cardiometabolic disorders: A systematic review of recent studies and possible mechanism of actions. Frontiers in Pharmacology, 13, Article 792794. https://doi.org/10.3389/fphar.2022.7927941 [25] Alia, F., Putri, M., Anggraeni, N., 2& Syamsunarno, M. R. A. (2022). The potency of Moringa oleifera Lam. as protective agent in cardiac damage and vascular dysfunction. Frontiers in Pharmacology, 12, Article 724439. https://doi.org/10.3389/fphar.2021.724439

Copyright

Copyright © 2025 Umme Rafiya Qureshi, Ruhi Baig, Agreni Chandrikapure, Sufiyan Ansari, Ganesh Akone, Faraz J Pathan, Rubina Imran Sheikh, Dr. Sayyad Sajauddin Gulab. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.