BACKGROUND Smoking is a major killer. It kills half of its users and lifetime smoker has 50% chance of smoking related death. Indians are heavy users of tobacco; people of lower socio-economic study commonly smoke bidis. Tobacco smoke contains 7000 compounds including phenols, carbohydrates and nitrosamines, many of which are carcinogenic. Nicotine, present in tobacco, is a vasoactive compound increasing vascular resistance. Acutely, smoking increases heart rate and BP within 10 minutes of

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... ure. There is a dose-response relationship between smoking and LV dysfunction. A Spanish study has shown smoking to be commonest risk factor for stroke. Cessation of smoking is the most cost effective strategy for CV disease prevention. Cessation of smoking reduces both MI and death irrespective of gender and duration of followup. BACKGROUND Smoking is the leading cause of preventable death and disease worldwide. Smoking kills about half of its users and a lifetime smoker has a 50% chance of dying due to smoking. Smokers on an average lose a full decade of their life as compared to < 3 years with severe hypertension. 1 While 1/3 rd of all tobacco related deaths are due to CVD (out of which CAD contributes 2/3 rd ), 11% of all CV deaths and 30% of CAD related mortality is due to smoking. 2 Smokers present with ACS 6 -13 years earlier than non-smokers. Smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and smoking cessation in these age groups is still beneficial in reducing the excess risk. More than 35% of adults in India use tobacco, out of which the most common form is bidis (53%) followed by cigarettes (19%) and the rest in smokeless form. 3 The interheart study demonstrated that all non-smoking forms of tobacco are equally potent aetiological factors in myocardial infarction.