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While the precise mechanisms by which smoking increases cardiovascular disease are still being discovered, it has been shown to exert direct myocardial effects, such as increasing myocardial oxygen demand, lowering the threshold for angina, and Impairing exercise performance (Figure 2)

Our present findings using HAPC analysis confirm these results and indicate that the smoking rate reductions for women and men parallel one another from 18 to 74 years of age, but men, relative to women, are consistently more likely to smoke across the life course (Fig