Acute cigarette smoking enhances adrenergic activity and thus may be associated with hemodynamic changes in the cardiovascular system. In this study, the acute effect of cigarette smoking on heart rate variability (HRV) was studied. Fifteen subjects were included in the study. Time domain (the mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences) and frequency domain (high-frequency, low-frequency ratio, and low-frequency/high-frequency ratio) parameters of HRV were obtained from all participants for each 5-minute segment: 5 minutes before and 5, 10, 15, 20, 25, and 30 minutes after smoking a cigarette. The mean R-R interval, the standard deviation of R-R interval, and the root mean square of successive R-R interval differences significantly decreased within the first 5-minute period compared with baseline, and then the standard deviation of R-R interval increased within the 20- to 30-minute period. The low-frequency high-frequency ratio significantly decreased within the first 5 minutes after smoking and then remained unchanged throughout the study period. Similarly, low-frequency and high-frequency power increased within the first 5 minutes compared with baseline. Acute cigarette smoking alters HRV parameters, particularly within the first 5 to 10 minutes after smoking.

ObjectiveBoth the incidence and the prevalence of end-stage renal disease (ESRD) in elderly patients are increasing worldwide. Elderly ESRD patients have been found to be more prone to depression than the general population. There are many studies that have addressed the relationship between sleep quality (SQ), depression, and health related quality of life (HRQoL) in ESRD patients, but previous studies have not confirmed the association in elderly hemodialysis (HD) patients. Therefore, the aim of the present study was to demonstrate this relationship in elderly HD patients.Patients and methodsSixty-three elderly HD patients (32 females and 31 males aged between 65 and 89 years) were included in this cross-sectional study. A modified Post-Sleep Inventory (PSI), the Medical Outcomes Study 36-item short form health survey, and the Beck Depression Inventory (BDI) were applied.ResultsThe prevalence of poor sleepers (those with a PSI total sleep score [PSI-4 score] of 4 or higher) was 71% (45/63), and the prevalence of depression was 25% (16/63). Of the 45 poor sleepers, 15 had depression, defined as a BDI score of 17 or higher. Poor sleepers had a significantly higher rate of diabetes mellitus (P = 0.03), significantly higher total BDI scores, and lower Physical Component Scale scores (ie, lower HRQoL) than good sleepers. The PSI-4 score correlated negatively with Physical Component Scale (r = −0.500, P < 0.001) and Mental Component Scale scores (r = −0.527, P < 0.001) and it correlated positively with the BDI score (r = 0.606, P < 0.001). In multivariate analysis, independent variables of PSI-4 score were BDI score (beta value [β] = 0.350, P < 0.001), Mental Component Scale score (β = −0.291, P < 0.001), and age (β = 0.114, P = 0.035).ConclusionPoor SQ is a very common issue and is associated with both depression and lower HRQoL in elderly HD patients.

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he vascular endothelium plays an integral role not only in regulation of vascular tonus, but also in prevention and formation of thrombus and inflammation. 1 It is known that endothelial dysfunction is associated with coronary risk factors and atherosclerosis, and has a close pathophysiological relation with acute coronary syndromes. [2][3][4] Endothelial dysfunction has been shown in patients with documented atherosclerosis, but it is also an early step in the pathogenesis of the atherosclerotic cascade. [5][6][7] Among various methods to assess endothelial function, endothelium-dependent vasodilatation (EDV) is a noninvasive, highly reproducible, simple method based on high-sensitivity ultrasound waves. 7,8 In this study we assessed the relationship between EDV in systemic arteries and coronary risk factors in patients with documented coronary artery disease (CAD). Methods Patient PopulationOne hundred and fifty patients with angiographically proven CAD (103 males, 47 females), age ranging between 29 and 78 years (mean: 58±10), were recruited. CAD was defined as the presence of angiographically demonstrated ≥70% stenosis in at least 1 major epicardial coronary artery. Hypertension (HT) was defined as blood pressure ≥140/ 90 mmHg or use of antihypertensive drugs and diabetes mellitus (DM) as fasting blood glucose level ≥126 mg/dl or use of antidiabetic agents. All study subjects underwent a complete physical examination, and biochemical, electrocardiographic and body mass index (BMI) measurements. Vascular endothelial function in the brachial artery was measured by the flow-mediated dilatation (FMD) technique. Patients with acute coronary syndromes, severe left ventricular dysfunction (ejection fraction <35%) or old myocardial infarction were excluded from the study. Vascular StudyEach subject was studied in the morning, after abstaining from alcohol, caffeine and tobacco, as well as food, within 8 h before the study. High-resolution echocardiography Doppler ultrasound (Technos MPX ultrasound ESOTA Inc) with an 8.0 MHz transducer was used to measure the Circ J 2007; 71: 698 -702 (Received August 1, 2006; revised manuscript received January 22, 2007; accepted February 9, 2007 Background Results of experimental and clinical studies suggest that both coronary artery disease (CAD) itself and its traditional risk factors lead to endothelial dysfunction. The aim of the present study was to determine which CAD risk factors sustain their contribution to endothelial dysfunction despite the presence of established CAD. Methods and ResultsThe study group comprised 150 patients with CAD. Using a high-resolution ultrasound, the diameter of the brachial artery at rest and during reactive hyperemia (flow-mediated dilatation, FMD%: endothelial-dependent stimulus to vasodilatation), as well as after sublingual administration of nitroglycerin (NTG%: endothelium-independent vasodilatation), was measured.

Coronary artery ectasia (CAE) is frequently considered as a form of coronary artery disease. Cardiovascular risk factors were determined in a patient population with CAE. The 51 patients with isolated CAE (group 1), 61 patients with CAE coexisting with significant coronary stenosis (group 2), and 62 subjects with significant coronary stenosis (group 3) were included in the study, and the distribution of cardiovascular risk factors was compared. Thirty of 51 patients with isolated CAE had presented with typical angina pectoris, 8 patients with unstable angina pectoris, and 13 patients had atypical chest pain or palpitation. The 21 of 51 patients with isolated CAE had definitive positive treadmill exercise test results. Positive family history was similar in each group. The history of smoking was similar in group 1 and group 2 but higher than group 3. Frequency of hypertension was similar in group 1 and group 2 but higher than that in group 3. Frequency of diabetes mellitus was similar in group 1 and group 2 but lower than group 3. Plasma lipid levels and the number of patients with lipid disturbances were also similar in each group. In addition, C-reactive protein (CRP) levels were above the normal limits and there was no difference among groups with respect to plasma CRP levels. CAE appears to be associated with traditional cardiovascular risk factors such as hypertension, smoking, and hyperlipidemia. In addition, elevated CRP level in patients with CAE may suggest the role of inflammatory process in development of CAE.