Early Improvement in Peripheral Vascular Tone following Smoking Cessation Using Nicotine Replacement Therapy: Aortic Wave Reflection Analysis

Abstract

Objectives: Cigarette smoking induces cardiovascular pathology and worsens arterial stiffness. Arterial stiffness can be assessed noninvasively based on 2 indices: pulse-wave velocity (PWV), indicating aortic stiffness, and the augmentation index (AIx), indicating aortic wave reflection. The impact of smoking cessation (SC) with nicotine replacement therapies (NRT) on arterial stiffness remains unknown. Methods: AIx and PWV were studied prospectively (using a SphygmoCor system) in 26 long-term smokers (>10 cigarettes/day; mean age 43 ± 6 years) before (visit 1) and 28 and 56 days (visit 2 and visit 3) after SC supported by NRT. Abstinence was ascertained when exhaled carbon monoxide (CO) was <10 ppm; the quantity of NRT absorbed was assessed based on the serum cotinine level. Results: Sixteen of 24 patients (67%) were abstinent at the end of the study; 8/24 had cut down on smoking, and 2 were lost to follow-up. CO and serum cotinine levels fell after SC. The mean AIx for the population as a whole was 23.4% at visit 1, with a significant early reduction by visit 2 (16.2%) and visit 3 (13.9%) (ANOVA, p < 0.001). The PWV, peripheral blood pressure, and heart rate were unchanged. Conclusions: The improvement in AIx and the stability of PWV after SC with NRT indicate improved peripheral vascular tone. This impact may account for the early clinical benefit of SC observed even when associated with NRT.

Quitting Smoking: An Action That Does Not Bounce Back

“…Several prospective studies using behavioral/cognitive and/or bupropion therapy have concluded that smoking cessation reduces wave reflections, whereas its effect on aortic stiffness is of less magnitude (see later) [10][11][12] . In line with these findings, Roux et al [4] demonstrated that smoking cessation reduced augmentation index, i.e. a measure of wave reflections, but not carotidfemoral pulse wave velocity, i.e.…”

“…Aortic stiffness depends on the level of blood pressure, and it increases as blood pressures rises. In the study of Roux et al [4] systolic blood pressure increased after smoking cessation. Although this finding seems unexpected, it is in line with previous observations [19] and it could be linked to increases in body weight after smoking cessation.…”

“…Another interesting issue in the study of Roux et al [4] was that not all subjects quit smoking: one third of them cut down on smoking and their serum cotinine levels were probably reduced (the authors do not provide a value for this parameter in this specific group of patients, but only for the whole study population). Although the decrease in augmentation index was not statistically significant in this group (p = 0.07), this was probably a sample size issue (in the total abstinent group, which was double in number compared to the reduced smoking group, the same approximate decrease in augmentation index was found to be statistically significant).…”

“…Several pharmacological interventions can assist in smoking cessation, such as nicotine-replacement therapy and treatment with bupropion, varenicline, etc. A study by Roux et al [4] published in a recent issue of Cardiology examines the effect of smoking cessation with nicotinereplacement therapy on arterial stiffness and wave reflections.…”

“…However, the effect of smoking cessation on arterial function has not been adequately examined, and the study by Roux et al [4] adds knowledge to this field. In a retrospective study, hypertensive patients who had quit smoking had reduced arterial stiffness and wave reflections compared to current smokers [9] .…”