<b>The Etiology of &lsquo;Smoker&rsquo;s Paradox&rsquo; in Acute Myocardial Infarction With Special Emphasis on the Association With Inflammation</b>

Abstract

SUMMARYDespite increased risk for coronary artery disease and acute myocardial infarction (AMI), prior studies have found that smokers with AMI have lower mortality rates than nonsmokers, a phenomenon often termed 'smoker's paradox'. The present study was designed to examine the etiology of 'smoker's paradox', especially with respect to the association with inflammation.The subjects included 528 consecutive AMI patients who were admitted within 24 hours of onset and underwent successful coronary intervention. Of the 528 subjects, 232 (44%) were smokers.The cardiac mortality rates over a 6 month period was significantly lower in the smoking group than the nonsmoking group (3% versus 9%, P = 0.01). There were significantly more male patients in the smoking group, and the smoking group was significantly younger than the nonsmoking group (P < 0.0001). The value of high sensitivity C-reactive protein (hs-CRP) on admission and 24 hours after onset, and serum amyloid A protein (SAA) were significantly higher, and acute phase BNP was significantly lower (hs-CRP on admission 1.36 ± 1.03 mg/dL versus 0.75 ± 0.82 mg/dL, P = 0.02, hs-CRP at 24 hours 3.86 ± 4.32 mg/dL versus 2.90 ± 3.46 mg/dL, P = 0.008, SAA; 288 ± 392 µg/dL versus 176 ± 206 µg/dL, P < 0.05, BNP; 248 ± 342 pg/mL versus 444 ± 496 pg/mL, P = 0.0002) in the smoking group than in the nonsmoking group. The early ST-segment resolution rate was higher in the smoking group compared with the nonsmoking group (80% versus 66%, P = 0.003).The reason why smokers with AMI have lower mortality rates than nonsmokers, the so-called 'smoker's paradox', is believed to be because smoking induces inflammation and smokers may have less damage to microvascular function after primary percutaneous coronary intervention. (Int Heart J 2008; 49: 13-24) Key words: Myocardial infarction, Smoking, Inflammation EVEN though many epidemiologic studies have shown that cigarette smoking is associated with higher rates of myocardial infarction and death from coronary From the

Impact of hypertension on the outcome of patients admitted with acute coronary syndrome

“…We assumed that preexisting hypertension might be protective in ACS patients in the short term despite its clearly established role in increasing the long-term risk for coronary artery disease. Similar paradoxes have been previously described for smokers [10] as well as for patients with obesity [11].…”

Passive Smoking in Never-Smokers Is Associated With Increased Plasma Homocysteine Levels Analysis of NHANES III Data

“…This effect is caused by various factors such as sympathetic activation and inflammation. 15,16) It has already been showed that passive smoking was linked to cardiovascular events, and in that study being a passive smoker was determined by interview alone.…”

Three-Year Clinical and Angiographic Outcomes After Everolimus-Eluting Stent Implantation in Patients With a History of Coronary Artery Bypass Grafting

“…Two types of EES were available for use in the study: Xience V TM (Abbott Vascular, Santa Clara, CA, USA; diameters of 2.50, 2.75, 3.00, and 3.50 mm and lengths of 8,12,15,23, and 28 mm) and Promus Element TM (Boston Scientific, Natick, MA, USA; diameters of 2.50, 2.75, 3.00 and 3.50 mm and lengths of 8,12,16,20,24, and 28 mm). When loading of dual antiplatelet drugs was necessary, patients received 300 mg…”

“…Some previous reports have shown that current smoking was not necessarily a risk factor for clinical events after PCI in the BMS era. 20,21) However, recent papers on interventional cardiology written after the emergence of DES showed that current smoking is an independent risk factor for stent thrombosis 22) and neoatherosclerosis, 23) which can be a cause of late catch-up restenosis after DES implantation. Our results strongly support comprehensive risk control including patient education as a means of improving clinical outcomes in high risk subsets even in the contemporary DES-PCI era.…”