ernia
and diabetes fnellitus (1).
and atheroscleroservations the prevalence of smoking and mortality from coromry heart disease
have declined, but 25% of all ~~~~~~v~s~~lar
deaths in the
developed countries are still attributable to cigarette smoking (3). Even in countries where the incidence of coronary
heart disease is relatively low, smoking shows
From the Departmentof Pharmacology,Divisionof ClinicalPharmacologyand Departmentsof Biophysicsand Physiology,CardiovascularResearch
Institute Maastricht,University of Limbuq, Maastricht,The Netherlands.
Manuscriptreceived March29, 1993;revised manuscriptreceived.iarne
1%
I Dr. M. J. F. Kool, Deparwnt of Pharmacology, University of Limburg, P. 0. Box 616, 6209 MD Maastricht,The
Netherlands.
81993 by
the AmericanColtegeof Cardiology
T
1. DemographicDatafor Smokersand Nonsmokers
Gender
Ageiyr)
Weight
(kg)
He&%(cm)
BU (m3,
Smokers
(n = 14)
Nonsmokers
(n = 14)
9Ml5F
37 (25-W
73 (55-88)
175(158-186)
1.9(M-2.1)
9M;SF
37(w-541
72 (52-931
174(161-183)
1.9(1.6-2.0)
Vahwsin [email protected] = body surfacearea, calculated
accord&~to tie fomwh of Ih Boisand Du Bois (14).
the left arm. Pulse pressure (AP) was ~efi~cd as ~y~to~~c
minus diastolic blood pressure.
bit& smokers (study 1). In addition, these!v
were compared with those in ~n~~~~~~~ subjects (study 2).
arm at heart level. The
whole arm was deiced in an incubator to keep c~vironm~ntal
nstant (28°C).In addition, the skin temperay a skin electrode thermomrature was similar before and
E&C common carotid
bl
every mmute. In addition, cardiac
flowwere determined before and
strain gauge, represent total (cutaneous and muscle) forearm
blood flow. Hand circulation was eliminated by inflating a
wrist cuff to suprasystolic pressure (220mm Hg) for 4 min.
Figure 1. The short-term effec’ of
smokingon vessel wall properties
of large arteries before (open bsrs)
and after (solid bars) smokingone
cigarette. Data are mean value -1SEM. *p c Q.05,**p < 0.01(diqerence between period before and after smoking).BA = brachialartery;
= complhce
coeficient;
::* = common carotid artery;
D = diameter; DC = distensibility
coefkient.
6
KWL E’K’AL.
I
SMOKING AND AK’I’ERIAL WALL PROPERTIES
3.
HemodynamicIMa for Smokers and Nonsmokers
Smokers
bighsic s&33, At low doses
Nonsmokers
of smoking can be explained by the ~~cot~~e~~~d~cc~
sympathetic activation. Nicotine induces t e release of both
epinephrine and ~orep~~e~bri~~,
thetic nerve activity has been
), the increase in plas
cts stimulation of the adre
peripheral mecba~~sms(e
nephrine clearance) (18)+The net
dependlenton the mixed
nephrine at the d~er~~t
it causes
medulla awd an
d
stimulation or direct
in these studies the increment in
is lower than the incrczss in heart
se short-term hemodynamiceffects
After a 4-h noasmoking period, heart rate at rest was
higher in habitual smokers than in nons~~lokers.This differcace could not be explained lay differences in physical
activity level in the two groups because, on average, smokers and nonsmokers beloved the same daily work and
s activatorswere comparabk. In previous studies,
smokers (26)the heart rate has been persistently
could to be elevated
of withdrawal phenomenon.
rs in our
study was not different from that in nonsmokers. Other
studies have been inconsistent with regard to blood pressure
in habitual smokers. Overall (X,27), casual as well as
ambulatory blood pressure values in habitual smokers have
2.
3.
om mtional vitsnlstatistics.
Lancet tW;J39: 1268-78.
Kiyohara Y, Ueda K, Fujishima M. Smoking and sar&vascu?x
discasf:
in the general population in Japan. J Hypertens I%%;8 Suppl %W-15.
Glantz SA, Rarmley VW. Passive sm0,king and heart disease. Epiderniology, physiology and biochemistry. Circulation 19%;83: 1-12.
Cruickshank JM, Neil-Dwyer G, Dorrance DE, Hayes Y, Pate1 S. Acuk
effects of smoking on blood pressure and cerebral blood flow. J
Hypertens 19&9;3:443-9.
7. LepPntalo M, Lassila 8. Smoking and occlusive arterial disease.
Sug %991;157:83-7.
8. Bijhler FR, Vesanen K. Walters JT.
Ii P. Impact of smoking on heart
attacks, strokes, blood pressure co
I, drug dO!X, iKId C$ldily Of life
aspects in the International Ptospeclive Primary Brevcntiori Study in
Hypcncasioa, Am Heart J 19Xi;l15:2#2-7.
9. DOllWy C, !%Wi~ii~ t?F. TktZ
lrial: the smoking pahnl. Am
10. Bcnowitz NL. Pharmacologica
addiction. N En@ J Med 1988;319:1318-30.
II.
function and kemostasis (20,34,35).
In addition, according to the current view of atherosclerotic disease, plaque ruptun is an important feature. Pt has
been demonstrated that most of the acute coronary syndromes are due to the disruption of small, nonstenotic
plaques (36). These small plaques are generally not detected
with the present diagnostic techniques and might already be
present in young smokers (36). Increased arterial wall stiffness, increased blood pressure ad a bigher heart rate are
short-term effects of smdhg that enhance the load on the
site. sf ~t~~~osc~e~ot~~
vessel wall. In addition, at t
plaques, the distribution of circu rential and tensile stress
is altered, which might further increase the load at the plaque
(37).The smoking-induced increased load at the atherosclerotic plaque may induce plaque rupture and lead to acute
ischemic events.
12.
13.
14.
15.
16.
Van Bortel LM. Hocks AFG, Kool MJF, ~~~~k~r~~o~dier
HA. Lntr~duclion to large artery properties as a target for risk reduction by
antihypertensive therapy. J Hypcrtcns 1992;10 Suppl6:S123-6.
Fuster V. Badimon L. Badimon JI, Chescbro IN. The pathogen&s of
coronary artery disease and the acute coronary syndromes. M Engl J Mcd
3!%?;324:242-50.
Hocks APG, Brands PJ, Smceta FAM. Rsneman WS. A~~CWIKW
the
distensibility of superficial wrterics. Witrasound f&d Biol I99%16:121-8.
Du Bois D, Du Bois EF;. A formula IO estimate the a~~ro~ima~~ surface
area if height and weight be known. Arch Intern Med 19f6;17%93=71.
ForconiS, Jagenau A, Cuerrini M, Pccchi S, Cappelli R. Strain gauge
plethysmojgraphy in the study of circulation of the limbs. Algiolegy
1979;30:487-97.
marI
Taylor P. Ganglionic siirldihg
and blocking agents. In:
and
Gilman A. Goodman LS, Rail TW, Murad F. editors. Goo
Gilman’s the Pharmdsological Basis of’~hera~~~t~~~, 7th ed. NW ‘Vork:
Macmillan, 1985215~-21.
of
17. Care CG, Lever MJ, Parker M-L Fish Pd. EfTtxt of eiga
the pattern of arterial bb3d flow: postiiblc insight i
underlying the developme@ of arlerinsclerosis. kaucsl 1%3%4:11-I%
IS. Grassi G, Scnvaile 8. Calhoun DA. BslJd 6, Manch G. CigarMe
smoking and the adrunergic m~ousi system. Clin Exp ~y~~~~n~
IAl
l992:A14:251-MI.
19. Berlin I, Cournot A, Renout P, Duchier J, S&W
KOOL ET AL..
SMOKING
AND ARTERK AL WALL
PROPERTIES
namic effects of smokingin babituai smokers. A methodological study.
Eur J Clin Fharmacol I!Mk38:57-60.
and local cold test: rno~~olog~c~~
29. Gasser P. Video~nailfold~microscopy
and hemodynamiccorrelates in 124 healthysubjects. Vasa ~~~:2~~24~~
20. Winp$ordMD.Smokingand cardiovascular function. J Hypertens199&g
Suppi5:SiY-23.
21, RichardsonD. Effectsof tobacco sm&e inhalation on capitlwr blood
flowin human skin. Arch Environ He&h 1%7;42:19-25. _ _
Jacobs MC, Lenders ,I, Kapma JA. Smits P. Thien T. The elect of
smokicingon vascular relaxation [abstn:ct] Pharm WeekblSci l!Wl:13
Suppl L:M
Cryw PE, HaymondMW, SantiagoJV, %ah SD. Nwpinephrine and
e&ephri& r&se and adrener& mediation of smokig&ociated
hemodwamic a& metabolic events. N Engl J Mcd 1976;295:573-7.
’ ephrine, epinephrine; and the sympathomimetic
AA, Onusi 0, Mansia
romplilrnce in man, J
and nanumokers:
51.
30. Lassila R, Seyberth NW, Haapanen A, Srhweer H, Koskenvuo M,
LaustiolaKE. Vawactiveand a&erogeniceffectsofcigarettesmoking:a
study of monozybotic twins discordant for smoking,
955-7.
31.
32.
33”
34.
35.
36.
37.