MODEL RELEASED. Smoking and heart disease. Concep- tual image of a man smoking a cigarette and heart disease depicted by a cardiac surgical team in the smoke. The risk of coronary artery disease of the heart in a young man who smokes 20 cigarettes a day is about three times that of a non-smoker, and this risk increases with the number of cigarettes smoked. Coronary artery disease leading to heart failure is the most common cause of death in middle-aged men in Western countries. Smoking may cause raised blood pressure, respiratory complications, and a hardening of the arteries, which are conditions all implicated in eventual heart failure.