Smoking is associated with an acute deterioration of aortic elastic properties. This effect of smoking may contribute to the unfavorable consequences of smoking on the cardiovascular system.

Aortic elastic properties are compromised and energy loss due to aortic wall viscosity is increased in hypertensives compared with normotensives. Function of the aorta is improved in both hypertensive and normotensive subjects after the administration of diltiazem.

Background-The safety and efficacy of percutaneous coronary intervention of de novo lesions in unprotected left main coronary arteries remains an unresolved issue. Methods and Results-We analyzed 67 consecutive patients treated with the following devices: 39 with stents, 12 with rotational atherectomy plus stents, 13 with directional coronary atherectomy plus stents (a total of 64 patients were treated with stents), and 3 patients with directional coronary atherectomy only. The reference vessel size was 3.78Ϯ0.73 mm and lesion length was 6.6Ϯ3.0 mm. In-hospital complications were 2 coronary artery bypass grafts (CABGs) (3.0%), 2 Q-wave myocardial infarctions (MIs) (3.0%), and 3 non-Q-wave MIs (4.5%); there were no deaths. The estimated cardiac survival at 3 years was 91%. The cardiac mortality rate was higher in patients with Parsonnet score Ͼ15 versus Յ15 (21.4% versus 4.2%, Pϭ0.02) at 3 years. The independent covariate of cardiac death was preserved left ventricular ejection fraction; for combined cardiac events (cardiac death, MI, repeat revascularization) it was large reference vessel size. Follow-up angiography at 5Ϯ2 months in 85% of eligible patients revealed 31.4% restenosis. Extending the follow-up to 31Ϯ23 months (19 patients with follow-up beyond 3 years) the cumulative event rates were 11 deaths (16.4%), 8 of them cardiac (11.9%), 2 (3.0%) MI, and 16 (23.9%) repeat revascularizations (CABG in 5 patients). Conclusions-Elective

The role of inflammation in the development of restenosis after percutaneous coronary interventions has been investigated in several studies. There is an interaction of inflammatory activation and vascular wall response to injury leading to intimal hyperplasia. Percutaneous interventions trigger inflammatory reactions leading to the development of intimal hyperplasia. This reaction is even more prominent in atheromatic plaques in which inflammatory cells have already been activated. In the clinical setting there are several methods for the recognition of the inflammatory activation. In this article we review the data for the role of inflammatory process in restenosis and the significance of identifying the inflamed lesions prior to the intervention. Moreover, the therapeutic implications for the inhibition of inflammatory activation are mentioned.

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Both passive and active smoking are associated with an acute deterioration in the elastic properties of the aorta. This association between exposure to tobacco smoke and aortic elasticity indicates that aortic function deteriorates during passive or active smoking.

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