The smoking prevalence in Europe varies from 14% in Sweden to nearly 38% in Greece.1 In the USA it is now approximately 20%, with large differences between states and according to social class and ethnic background.2 The proportions of men and women smoking is rather variable, but the relative risk of cardiovascular diseases seems to be higher in women.3 Smoking prevalence decreases with higher educational level and higher family income. Smoking is a major risk factor for lung, cardiovascular and other diseases.4 ,5 Smokers double their risk of having a heart attack compared with non-smokers4 and many people die from diseases related to smoking.

The effects of nicotine, like those of other drugs with the potential for abuse and dependence, are centrally mediated. The impact of nicotine on the central nervous system is neuroregulatory in nature, affecting biochemical and physiological functions in a manner that reinforces drug-taking behaviour. Dose-dependent neurotransmitter and neuroendocrine effects occur as plasma nicotine levels rise when a cigarette is smoked.6 Smokers have increased blood cholesterol levels. Smoking may also stimulate the blood clotting system in the blood, and the cardiovascular risk in smoking women using contraceptives is increased.

Cardiovascular diseases occur more frequently in people with elevated C-reactive protein.7 The …