**16. Impact of family history on COVID 19**

There are certain non-modifiable risk factors involved in the pathogenesis of hypertension; one of the essential factors is family history. Various family grounds the inherited character of hypertension examines, exhibiting the relationship of circulatory strain among kin and guardians and youngsters [39].

Hereditary attributes identified with hypertension, for example,


*Impact of Cardiovascular Diseases on the Outcome of Patients with COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.101121*

• The Environmental Factors Like More Intake Of Sodium In The Diet [40].

The prevalence of CVD and family history are interlinked. The patient with hypertension with a family history is double in value than the patient with no family history [15]. Various types of research indicate that the person having a family history of hypertension leads to premature changes in the cardiac system, including ventricular wall thickness and differences in vascular permeability and stress responses [41, 42].

### **17. Impact of smoking on COVID 19**

The side effect of smoking is prominent, and it causes mortality in all the body system linked with cardiovascular, respiratory systems, and diabetes. Smoking is a significant risk factor for all kinds of cardiovascular infections. It has expanded the risk of getting coronary heart disease. The rate of mortality has increased by 70% from coronary heart disease because of smoking.

It impacts the myocardium, obstructs the blood supply, and increases the chances of atherosclerosis, which directs myocardial infarction and different infections from cardiovascular problems, including cardiomyopathy. The tobacco content incorporated the nicotine and carbon monoxide directly impacts vascular endothelium, which causes inflammation and thrombosis. The majority of individuals with smoking are in danger of developing atherosclerosis.

Smoking has equally been troubled in the progression of corpulmonale. However, a close relationship with congestive cardiovascular breakdown has not been set up.

The proportion of myocardial oxygen supply and demand is influenced by nicotine and carbon monoxide, resulting in vascular endothelial injury, prompting the atherosclerosis plaque's progression [43].

#### **18. Effect of smoking on coronary heart disease**

Cigarette smoking is a significant modifiable factor for developing coronary illness. Due to cigarette smoking, the patients breathe tar; this substance contains 4,000 synthetics and cancer-causing agents, including cyanide, formaldehyde, and smelling salts. The nicotine is delivered by smoking which stimulates the sympathetic nervous system, causes peripheral vasoconstriction, and displays tachycardia, hypertension, and increased cardiac workload. Smoking affects the respiratory tract by causing hyperplasia that enhances the abnormal production of mucus. Hyperplasia obstructs the airway due to excessive secretion. Smoking causes the enlargement of the distal air spaces with obliteration of the alveolar walls. Thickening and narrowing of the airway wall cause the inflammatory exudates in the airway lumen.

Carbon monoxide (CO) is a part of tobacco smoke, which absorbs the increased hemoglobin and reduces the O2-carrying capacity to blood. Smoking causes inflammation, vasoconstriction, clot formation, and hypoxia in the endothelial system. Individuals who smoke are at high risk for the development of atherosclerosis. Endothelial injury causes thrombosis [44]. Coronary thrombosis can cause cataclysmic heart damage that leads to sudden death. Nicotine acts on the sympathetic nervous system and decreases myocardial oxygen, causing angina [45]. Tobacco smokers are bound to encounter intense cardiovascular occasions at an early age and prior illness. It has been proved that smoking can adversely affect the lungs, destructing the immune system and making it prone to developing infections.

Smokers are prone to develop pulmonary infections and reduce pulmonary immune function. World Health Organization (WHO) expressed that individual who smokes, carries the fingers to the lips, and that expands the chances of hand to mouth infection transmission, which is generally seen in COVID patients [46].
