Impact of Smoking and Smoking Cessation on Arterial Stiffness and Aortic Wave Reflection in Hypertension

Abstract

Abstract-Cigarette smoking is an important modifiable cardiovascular risk factor and pathophysiological mechanisms may include a stiff vascular tree. Although smokers have stiffer arteries, whether smoking cessation is associated with reduced arterial stiffness is not known. We compared never-treated patients with essential hypertension (nϭ554) aged 18 to 80 years (56% females) classified as current smokers (nϭ150), ex-smokers (nϭ136), and nonsmokers (nϭ268). Ex-smokers were categorized into Ͻ1 year, Ͼ1 and Ͻ10 years, and Ͼ10 years of smoking cessation. Key Words: smoking Ⅲ arterial stiffness Ⅲ pulse wave velocity Ⅲ augmentation index Ⅲ hypertension Ⅲ smoking cessation C igarette smoking is one of the most important avoidable causes of cardiovascular diseases worldwide, 1 and arterial stiffness may be one of the underlying pathophysiological mechanisms. Chronic cigarette smoking has been shown to be associated with increased arterial stiffness 2,3 and increases immediately after smoking 1 cigarette. 3 The standard measurement of arterial stiffness, aortic pulse wave velocity (PWV) in conjunction with augmentation index (AIx), an estimate of aortic wave reflection, provide a comprehensive assessment of arterial stiffness. 4 There is evidence that both PWV 5,6 and AIx 7 are independent predictors of cardiovascular events.Smoking cessation is an important lifestyle measure for the prevention of cardiovascular disease, and patients with myocardial infarction may experience as much as a 50% reduction in risk of reinfarction, sudden cardiac death, and total mortality if they quit smoking. 8 However, the speed and magnitude of risk reduction when a smoker quits is debatable, with studies quoting 3 to 20 years of smoking cessation associated with significant risk reductions in coronary artery disease. 8 Whether long-term smoking cessation is associated with a reduction in arterial stiffness compared with chronic smokers is not known. Therefore, we compared differences in arterial stiffness among nonsmokers, ex-smokers, and current smokers in a cross-sectional study. Methods SubjectsA total of 554 untreated subjects aged 18 to 80 years (47.8Ϯ0.6 years, meanϮSEM), 56% female, undergoing assessment for hypertension, were studied. None of the patients had secondary hypertension, coronary artery disease, valvular heart disorders, dysrhythmias, diabetes, heart failure, or renal impairment, and none were taking any vasoactive drugs. Current smokers were defined as those who had smoked Ͼ1 cigarette per day for Ն1 year, nonsmokers as those who had never smoked, and former or ex-smokers as those who had stopped smoking Ն1 month before examination. Ex-smokers were categorized into 3 subgroups according to smoking cessation duration: those who quit cigarette smoking for Ͻ1 year, between 1 and 10 years, and Ͼ10 years.Body weight, height, waist, and hip measurements were recorded in each patient. Body mass index (BMI) was calculated as body weight (kilograms) divided by height (meters squared), and the waist:hip ratio was calculated....

Obesity as an independent influential factor for reduced radial arterial wave reflection in a middle-aged Japanese male population

“…Smoking status, WBC count and LDL cholesterol level were also independently associated with AI in this study. These results are consistent with those in previous studies conducted in other ethnic groups, [26][27][28] and indicate that the relationships are also valid in the present population.…”

Association of blood pressure levels with the effects of alcohol intake on the vasculature in Japanese men

“…Thirdly, we did not analyze the confounding of the results by lifestyle variables; for example, (1) non-drinkers are less likely to exercise regularly, 26 and this has been shown to affect the rate of progression of arterial stiffening; 6,7 (2) a high salt intake related to heavy drinking may act to increase the arterial stiffness; 27,28 (3) although smoking was not found to be significantly related to the changes in the brachial-ankle PWV during the study period in this study, it is thought to increase the rate of arterial stiffness. 29 Because of the limited number of study subjects who did not smoke in this study, a study to examine the interaction of the effect of alcohol intake and that of smoking on the rate of progression of arterial stiffness is proposed. Fourthly, in relation to the lifestyle modifications in this study protocol, only 10% (40/378) of the subjects classified into the heavy alcohol intake group succeeded in lowering their alcohol intake and thus in shifting to the moderate alcohol intake group.…”

A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury

“…non-acute exercise) interventions. Two articles were case-control studies, 69,70 11 were of the pre-post design, 24,71-75 one was a case report and one was an RCT. The Non-Acute Exercise category (n ¼ 15) included passive leg exercise (n ¼ 1), 49 FES (n ¼ 5), 65,[70][71][72][73] upper body exercise (n ¼ 2), 69,76 an electrically stimulated resistance training regimen (n ¼ 3), 24,67,68 hybrid exercise (n ¼ 3) 66,74,75 and BWSTT (n ¼ 1).…”

“…[1][2][3] Increased vascular stiffness is thought to cause an amplified pulse pressure, a reduction in pressure buffering, 4 propagate increased ventricular tension and is a primary marker of cardiovascular disease risk. 5,6 Increasing vascular stiffness is related to advancing age, 7,8 poor nutrition, 9,10 smoking, 11,12 excessive alcohol consumption, 2,13,14 other chronic conditions (such as heart disease) 15 and low levels of physical activity. 16 Owing to the lack of mobility and the loss of autonomic regulation, people with SCI are particularly susceptible to alterations in both central and peripheral vascular function.…”