**3. Promoting cessation of smoking and tobacco use**

The health effects of tobacco use, including on CVD, and various public health measures to control it are well known [2, 10]. Harmful tobacco products also include smokeless tobacco like snuff, gutkha, gul, chimo, mawa, nass, pan masala, tambaku and others [22].

**Clinical management perspective:** The five A's framework (Ask, Advise, Assess, Assist, Arrange) has been developed to allow physicians to incorporate smoking cessation counseling into busy clinical practices [23]. Others have further added 'Assess again'. There are various pharmacological agents available to help patients quit smoking and tobacco use. However, before such products were available and even now hundreds of thousands of people including health professionals have had stopped tobacco use once they realized the possible complications to them. Physicians' priority, repeated advice and time spent on explaining its importance and its process of quitting play a crucial role for the motivation of the patients to quit tobacco use. Smokers who quit smoking abruptly ('Cold Turkey' method) have been reported to be successful than those who quit gradually [24]. However, the most important wellknown point, to emphasize to the patients repeatedly, is that after stopping tobacco use whether abruptly or slowly, it should not be used even once; otherwise the habit is likely to be resumed.
