The relationship between smoking and the cardiovascular health of athletes and exercisers: a systematic review on risks, performance and prevention
Abstract
Introduction: Smoking is a leading preventable cause of cardiovascular disease worldwide. Its deleterious effects, including endothelial dysfunction, increased arterial stiffness, and hypertension, are well established in the general population. However, the assumption that physical fitness may neutralize these risks in athletes remains unproven.
Objectives: This review aimed to evaluate the cardiovascular effects of active and passive smoking among athletes and physically active individuals. Specific goals included examining pathophysiological impacts, assessing performance deficits, identifying smoking prevalence, and reviewing preventive strategies.
Methodology: A systematic review was conducted in accordance with PRISMA guidelines. Databases included PubMed, SciELO, Web of Science, Scopus, SPORTDiscus, and LILACS. Inclusion criteria comprised studies involving athletes or regular exercisers (>3x/week), published between 2000 and 2025, addressing smoking's cardiovascular impact. Data extraction included study design, population, exposure type, and cardiovascular outcomes. Methodological quality was assessed using NOS, AMSTAR 2, and JADAD tools.
Results: Fifty-two studies were analyzed. Smoking was consistently associated with endothelial dysfunction (73%), increased blood pressure (52%), and reduced heart rate variability. Arterial stiffness and carotid thickening were observed in 22 studies, even among young athletes. Performance deficits included reduced VO₂ max (29…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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