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Cardiovascular disease is a well-documented health effect associated with smoking. Smoking introduces toxins into the body that contribute to the development of atherosclerosis, which is the buildup of plaques in the arteries. This condition narrows the arteries and can lead to hypertension, heart attacks, and strokes. Furthermore, smoking is known to raise levels of bad cholesterol and reduce good cholesterol, further exacerbating the risk of cardiovascular issues.

While the other choices may also have connections to smoking, the association is not as robust as it is with cardiovascular disease. Kidney disease can occur with long-term smoking, but the direct relationship is less clear. Dementia may have some correlations with smoking, particularly vascular dementia, but this is not as commonly emphasized in clinical studies compared to cardiovascular impacts. Gastrointestinal disorders, while potentially influenced by smoking, do not exhibit the same level of direct causation that cardiovascular disease does. Therefore, the significant link between smoking and various cardiovascular complications makes this the most pertinent answer.