• tar, a carcinogen (substance that causes cancer)
  
   
• nicotine increases cholesterol levels in your body
  
   
• carbon monoxide reduces oxygen in the body
  
   
• components of the gas and particulate phases cause chronic obstructive pulmonary disorder (COPD).
  
   

• the number of cigarettes smoked
  
   
• whether the cigarette has a filter
  
   
• how the tobacco has been prepared.

Cardiovascular disease

Cardiovascular disease is the main cause of death due to smoking.

Hardening of the arteries is a process that develops over years, when cholesterol and other fats deposit in the arteries, leaving them narrow, blocked or rigid. When the arteries narrow (atherosclerosis), blood clots are likely to form.

Smoking accelerates the hardening and narrowing process in your arteries: it starts earlier and blood clots are two to four times more likely.

Cardiovasular disease can take many forms depending on which blood vessels are involved, and all of them are more common in people who smoke.

• Coronary thrombosis: a blood clot in the arteries supplying the heart, which can lead to a heart attack. Around 30 per cent are caused by smoking.
  
   
• Cerebral thrombosis: the vessels to the brain can become blocked, which can lead to collapse, stroke and paralysis.
  
   
• If the kidney arteries are affected, then high blood pressure or kidney failure results.
  
   
• Blockage to the vascular supply to the legs may lead to gangrene and amputation.

Smokers tend to develop coronary thrombosis 10 years earlier than non-smokers, and make up 9 out of 10 heart bypass patients.

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Cancer

Smokers are more likely to get cancer than non-smokers. This is particularly true of lung cancer, throat cancer and mouth cancer, which hardly ever affect non-smokers.

The link between smoking and lung cancer is clear.

• Ninety percent of lung cancer cases are due to smoking.
  
   
• If no-one smoked, lung cancer would be a rare diagnosis - only 0.5 per cent of people who've never touched a cigarette develop lung cancer.
  
   
• One in ten moderate smokers and almost one in five heavy smokers (more than 15 cigarettes a day) will die of lung cancer.

The more cigarettes you smoke in a day, and the longer you've smoked, the higher your risk of lung cancer. Similarly, the risk rises the deeper you inhale and the earlier in life you started smoking.

For ex-smokers, it takes approximately 15 years before the risk of lung cancer drops to the same as that of a non-smoker.

If you smoke, the risk of contracting mouth cancer is four times higher than for a non-smoker. Cancer can start in many areas of the mouth, with the most common being on or underneath the tongue, or on the lips.

Other types of cancer that are more common in smokers are:

• bladder cancer
  
   
• cancer of the oesophagus
  
   
• cancer of the kidneys
  
   
• cancer of the pancreas
  
   
• cervical cancer

COPD

Chronic obstructive pulmonary disease (COPD) is a collective term for a group of conditions that block airflow and make breathing more difficult, such as:

• emphysema - breathlessness caused by damage to the air sacs (alveoli)
  
   
• chronic bronchitis - coughing with a lot of mucus that continues for at least three months.

Smoking is the most common cause of COPD and is responsible for 80 per cent of cases.

It's estimated that 94 per cent of 20-a-day smokers have some emphysema when the lungs are examined after death, while more than 90 per cent of non-smokers have little or none.

COPD typically starts between the ages of 35 and 45 when lung function starts to decline anyway.

In smokers, the rate of decline in lung function can be three times the usual rate. As lung function declines, breathlessness begins.

As the condition progresses, severe breathing problems can require hospital care. The final stage is death from slow and progressive breathlessness.

 

• Smoking raises blood pressure, which can cause hypertension (high blood pressure) - a risk factor for heart attacks and stroke.
  
   
• Couples who smoke are more likely to have fertility problems than couples who are non-smokers.
  
   
• Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to ease.
  
   
• The blood vessels in the eye are sensitive and can be easily damaged by smoke, causing a bloodshot appearance and itchiness.
  
   
• Heavy smokers are twice as likely to get macular degeneration, resulting in the gradual loss of eyesight.
  
   
• Smokers run an increased risk of cataracts.
  
   
• Smokers take 25 per cent more sick days year than non-smokers.
  
   
• Smoking stains your teeth and gums.
  
   
• Smoking increases your risk of periodontal disease, which causes swollen gums, bad breath and teeth to fall out.
  
   
• Smoking causes an acid taste in the mouth and contributes to the development of ulcers.
  
   
• Smoking also affects your looks: smokers have paler skin and more wrinkles. This is because smoking reduces the blood supply to the skin and lowers levels of vitamin A.
  
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For men in their 30s and 40s, smoking increases the risk of erectile dysfunction (ED) by about 50 per cent.

Erection can't occur unless blood can flow freely into the penis, so these blood vessels have to be in good condition.

Smoking can damage the blood vessels and cause them to degenerate: nicotine narrows the arteries that lead to the penis, reducing blood flow and the pressure of blood in the penis.

This narrowing effect increases over time, so if you haven't got problems now, things could change later.

Erection problems in smokers may be an early warning signal that cigarettes are already damaging other areas of the body - such as the blood vessels that supply the heart.

The 'side-stream' smoke that comes off a cigarette between puffs carries a higher risk than directly inhaled smoke.

Children who grow up in a home where one or both of their parents smoke have twice the risk of getting asthma and asthmatic bronchitis. They also have a higher risk of developing allergies.

Infants under two years old are more prone to severe respiratory infections and cot death.

For adults, passive smoking seems to increase the risk of lung cancer, but the evidence for an increased risk of heart disease is not yet conclusive.