ITC Project

Global Ignorance of Tobacco’s Harm to Cardiovascular Health Costing Lives

A report released April 20, 2012 at the World Heart Federation World Congress of Cardiology in Dubai reveals significant gaps in public awareness regarding the cardiovascular risks of tobacco use and secondhand smoke. The report, entitled "Cardiovascular harms from tobacco use and secondhand smoke", was commissioned by the World Heart Federation and written by the International Tobacco Control Project (ITC Project), in collaboration with the Tobacco Free Initiative at the World Health Organization.

Global ignorance of tobacco's harm to cardiovascular health costing lives

  • 70 per cent of Chinese smokers, 50 per cent of Indian smokers and 40 per cent of Dutch smokers are unaware that smoking causes stroke
  • In the UK, the USA, and Australia, nearly half of smokers are unaware that secondhand smoke causes heart attacks in non-smokers

According to the report, half of all Chinese smokers and one-third of Indian and Vietnamese smokers are unaware that smoking causes heart disease.  Across a wide range of countries, including India, Uruguay, South Korea and Poland, around half of all smokers - and over 70 per cent of all Chinese smokers - do not know that smoking causes stroke. Awareness of the risk of secondhand smoke is even lower. In Vietnam, nearly 90 per cent of smokers and non-smokers are unaware that secondhand smoke causes heart disease.  In China, 57 per cent of smokers and non-smokers are unaware of the link.  Even in countries with well-developed health systems and tobacco control regulation - such as Canada, the United Kingdom, the United States, and Australia - between a third and a half of smokers do not know that secondhand smoke can damage cardiovascular health.

 Professor Geoffrey T. Fong at the University of Waterloo, Canada, and Chief Principal Investigator of the ITC Project, commented, "This report shows a broad correlation between poor knowledge of the risks of tobacco use and high levels of smoking prevalence. To break this link and reduce the deadly toll of tobacco, more needs to be done to increase awareness of the specific health harms. Our research shows that the risks of tobacco use to lung health are very widely accepted. But we need to attain the same level of knowledge and awareness that tobacco use can cause heart disease, stroke, and peripheral vascular disease and secondhand smoke can cause heart attack. Health warning labels are known to be an effective method for educating the public on the health harms of tobacco products. A number of countries have introduced warnings about the increased risk of heart disease or heart attack, but no country has yet implemented a label to warn people that secondhand smoke causes heart disease. Increasing knowledge of these specific health risks will help encourage smokers to quit and help non-smokers protect themselves, so raising awareness is an important step in reducing people's exposure to tobacco smoke."

 Cardiovascular disease (CVD) is the world's leading cause of death, killing 17.3 million people every year. Eighty per cent of these deaths occur in low- and middle-income countries, which are increasingly being targeted by the tobacco industry. Tobacco use and secondhand smoke exposure causes about one-tenth of global deaths from CVD. Even smoking a few cigarettes a day significantly increases the risk of heart disease. Smokeless tobacco products have also been linked to an increased risk of heart disease and stroke. Secondhand smoke exposure increases the risk of heart disease by 25-30 per cent and more than 87 per cent of worldwide adult deaths caused by secondhand smoke are attributable to CVD.

 Johanna Ralston, CEO of World Heart Federation, commented: "If people don't know about the cardiovascular effects of tobacco use and secondhand smoke exposure, they cannot understand how much or how quickly smokers are endangering not only their own lives, but those of family members, friends, co-workers or other non-smokers who breathe tobacco smoke. In countries like India or China, so many people are at high risk for heart attack or stroke, and it strikes at a relatively early age: risks of CVD are far more present and immediate than most of the better-known fatal effects of tobacco use and secondhand smoke exposure. Knowing about cardiovascular risks of tobacco will help smokers take quitting seriously, and encourage people to demand and comply with policies that protect everyone from the harms of tobacco. The World Heart Federation calls on governments around the world to a make these policies an immediate priority, as they committed to do last year through the Political Declaration of the United Nations' High-level Meeting on the Prevention and Control of Non-communicable Diseases."

 Dr. Douglas Bettcher, Director of the World Health Organization's Tobacco Free Initiative, noted that, "This report provides conclusive proof that the level of information people have about the cardiovascular harms of tobacco use and secondhand smoke is still insufficient and therefore mass media campaigns and warnings are urgently needed to make people aware of these lethal harms. In fact, to avoid the enormous toll of needless deaths caused by tobacco use, a special UN high level meeting on non-communicable diseases recently called upon Parties of the WHO Framework Convention on Tobacco Control (WHO FCTC) to accelerate implementation of this Convention, recognizing the full range of measures, including measures to reduce tobacco consumption and availability. I hope that this report will boost the sense of urgency that world leaders and the public health community are trying to instill into the implementation of the WHO FCTC.  This will mean the difference between death and life for almost six million people each year."

 The report, which presents data from two major global tobacco research and surveillance studies - the Global Tobacco Surveillance System (GTSS) and the ITC Project - recommends three steps to reduce the current and future cases of CVD due to tobacco use - which may total over 100 million people - among the one billion people throughout the world who smoke today, and of their families exposed to secondhand smoke:

  1. Support tobacco control policies outlined in the Framework Convention on Tobacco Control (FCTC), including those that:
    1. Increase the price of tobacco products
    2. Eliminate tobacco promotion and marketing
    3. Implement 100 per cent smokefree laws in workplaces and public places - which is proven to significantly lower hospital admissions for heart attacks
    4. Make the necessary step-change in public awareness through committing to population-level strategies, such as large graphic warnings on tobacco product packaging and mass media public education campaigns - including warnings and messages about the risk of smoking and secondhand smoke to cardiovascular health
    5. Introduce plain packaging to discourage youth from starting smoking
  2. Increase training in cessation advice and support among health professionals
  3. Implement programmes and protocols to ensure cessation advice, support and aids are provided systematically

  The report is available here, or at:


Notes to Editors

For more information please contact:

Tracey Johnston - Email: - Tel: +44 7762 310248

Rima Taha - Email: - Tel: +971 55 2993234

Joanne Basford - Email: - Tel: +971 56 6800 234

Charanjit Jagait - Email: - Tel: +41 22 807 0334 or +41 79 625 3296

About the World Congress of Cardiology

The World Congress of Cardiology Scientific Sessions (WCC) is the official congress of the World Heart Federation and is held every two years. Through the Congress the World Heart Federation offers an international stage for the latest developments in science and public outreach in the field of cardiovascular health. The WCC places emphasis on the complementary nature of science and public outreach and strives to spread the message that through individual, community and patient-care interventions, the growing epidemic of cardiovascular diseases can be prevented. For more information, please visit:; keep up with the conversation on Twitter using the hashtag #WCC2012Dubai

About the World Heart Federation

The World Heart Federation is dedicated to leading the global fight against heart disease and stroke with a focus on low- and middle-income countries via a united community of more than 200 member organizations. With its members, the World Heart Federation works to build global commitment to addressing cardiovascular health at the policy level, generates and exchanges ideas, shares best practice, advances scientific knowledge and promotes knowledge transfer to tackle cardiovascular disease - the world's number one killer. It is a growing membership organization that brings together the strength of medical societies and heart foundations from more than 100 countries. Through our collective efforts we can help people all over the world to lead longer and better heart-healthy lives. For more information, please visit:;;

About The ITC Project

The International Tobacco Control Policy Evaluation Project (the ITC Project) is an international research collaboration involving 100 tobacco control researchers and experts from 23 countries (Canada, United States, United Kingdom, Australia, Ireland, Thailand, Malaysia, China, South Korea, New Zealand, Mexico, Uruguay, France, Germany, The Netherlands, Brazil, Mauritius, Bangladesh, Bhutan, India, Kenya, Zambia, and Nigeria) who have come together to conduct research to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC), the world's first health treaty. These policies include more prominent warning labels (including graphic images), comprehensive smoke-free laws, restrictions or bans on tobacco advertising, promotion, and sponsorship, higher taxes on tobacco products, removal of potentially deceptive labelling (e.g., "light" and "mild" and packaging design that lead consumers to the misperception that certain brands may be less harmful), promotion of cessation, education of public on the harms of tobacco, reduction of illicit trade, reduction of youth access, and product regulation. In each country, the ITC Project team conducts longitudinal cohort surveys and capitalizes on natural experiments to evaluate the impact of these policies over time. ITC Surveys contain over 150 measures of tobacco policy impact and have been conducted in countries inhabited by over 50% of the world's population, 60% of the world's smokers, and 70% of the world's tobacco users. Reports can be downloaded at

Global Tobacco Surveillance System

In 1998, the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and partners initiated the Global Tobacco Surveillance System (GTSS) to assist countries in establishing tobacco control surveillance and monitoring programs. GTSS includes collection of data through three school-based surveys: the Global Youth Tobacco Survey (GYTS), the Global School Personnel Survey (GSPS), and the Global Health Professions Student Survey (GHPSS), and one household survey: the Global Adult Tobacco Survey (GATS). GTSS provides a consistent framework for surveillance including standard sampling procedures, core questionnaire items, training in field procedures, data analysis, and consistent reporting across all participating countries. GTSS also enhances the role of government and the nongovernmental sector in surveillance, monitoring of tobacco use and key tobacco control indicators, and policy and program interventions. The synergy between countries passing tobacco control laws, regulations or decrees, ratifying and complying with the WHO Framework Convention on Tobacco Control, and conducting GTSS surveys offers opportunities to develop, implement, and evaluate comprehensive tobacco control policies. GTSS reflects WHO's, CDC's and partners' ongoing efforts to establish tobacco control surveillance and monitoring programs to track trends over time in tobacco-related knowledge, attitudes, behaviors and environmental influences.