UWorld Internal Medicine Practice Test

Smoking is considered the most important modifiable risk factor for coronary artery disease (CAD) because it significantly increases the risk of developing this condition and has profound effects on cardiovascular health. The harmful substances in tobacco smoke contribute to the development of atherosclerosis, which is the buildup of plaques in the arteries. This process narrows the coronary arteries, reducing blood flow to the heart muscle and increasing the risk of ischemia, heart attacks, and other cardiovascular events.

In addition, smoking exacerbates other risk factors, such as hypertension and high cholesterol, and diminishes the beneficial effects of high-density lipoprotein (HDL) cholesterol. The cessation of smoking leads to substantial improvements in cardiovascular health, including a marked decrease in the risk of heart disease. Therefore, reducing or eliminating smoking is paramount in the primary prevention of CAD and in improving overall cardiovascular outcomes. Thus, while other risk factors like hypertension, high cholesterol, and diabetes are also significant, smoking has a uniquely profound impact and is often prioritized in preventive cardiovascular strategies.