Another Smoking Gun Linking Cigarettes and Heart Disease

That cigarette smoking is harmful to the heart has long been maintained by a variety of concerned health professionals— and just as vehemently denied by the tobacco industry. This denial is made possible because the evidence linking cigarette smoking to ischemic heart disease is largely indirect and circumstantial, ie, smokers have a greater chance of developing and dying from coronary artery disease than do nonsmokers. This association has been confirmed by one epidemiologic survey after another, but what is lacking are smoking guns, direct connections between cigarettes and cardiac pathophysiology. In this issue of The Journal, Barry and colleagues¹ supply a smoking gun that is especially important because it relates to real-life settings rather than the experimental laboratory.

The smoking gun is really a small box, the Holter monitor, previously used only to record arrhythmias and conduction disturbances but in the last several years adapted to a new use—the