SMOKING AS A CENTRAL DRIVER OF CARDIOVASCULAR DISEASE AND CANCER: IMPLICATIONS FOR INTEGRATED CARDIO-ONCOLOGY PREVENTION

Resumo

Background: Cardiovascular disease (CVD) and cancer are the leading causes of death worldwide and increasingly recognized as interconnected conditions within the field of cardio -oncology. These diseases share multiple modifiable risk factors and biological mechanisms, with smoking emerging as the most significant and preventable contributor. Tobacco exposure induces systemic inflammation, oxidative stress, endothelial dysfunction, and direct DNA da mage, creating a common pathophysiological substrate for both atherosclerosis and carcinogenesis. Objective: To review the role of smoking as a central shared risk factor for CVD and cancer, and to highlight the importance of integrated screening and preventive strategies in high-risk populations, particularly current and former smokers. Methods: A narrative review of the literature was conducted, focusing on high -impact publications and guidelines from major international journals and societies (including The Lancet, NEJM, JAMA, BMJ, and GOLD reports). Studies addressing epidemiological associations, biological mechanisms, and preventive strategies linking smoking, cardiovascular disease, and cancer were included. Results: Smoking increases the risk of coronary artery disease by two- to four-fold and accounts for approximately 30% of cardiovascular mortality. Concurrently, it is responsible for nearly 30% of all cancer deaths and up to 85-90% of lung cancer cases. Shared mechanisms include chronic inflammati on, immune dysregulation, pro -thrombotic states, and genomic instability. Notably, the excess risk persists for years after smoking cessation, particularly among heavy former smokers. Evidence supports structured screening strategies, such as annual low -dose computed tomography for lung cancer in individuals aged 50 -80 years with significant smoking history, as recommended by major guidelines. In addition, chronic obstructive pulmonary disease (COPD), frequently underdiagnosed in smokers, represents an impo rtant intermediary condition that further amplifies both cardiovascular and oncologic risk. Conclusion: Smoking is a central and unifying driver of both cardiovascular disease and cancer. A cardio - oncology approach integrating systematic smoking assessment , early detection strategies, and aggressive cessation interventions is essential to reduce morbidity and mortality. Multidisciplinary models targeting shared risk factors, particularly smoking, should be prioritized in clinical practice and public health policies.