Smoking and cardiovascular diseases – is there more paradox than expected?

Abstract

risk factors in primary, secondary, and tertiary prevention of CVD. Smoking cessation in tertiary prevention is the most important single lifestyle intervention and its effect is stronger than lipid profile modification. 6 The devastating effect of tobacco smoke is related to a mixture of more than 7000 chemicals contributing to endothelial dysfunction, inflammation, dyslipidemia, vascular and hemodynamic function, and a prothrombotic state. Cigarette smoking influences all phases of atherosclerosis from endothelial dysfunction to the occurrence of acute coronary syndrome (ACS). Smoking induced activation of inflammation is characterized by increased plasma levels of fibrinogen, C-reactive protein, and interleukin 6. 6,7 In patients with ACS, smoking is associated with higher levels of inflammation markers and infarct zone hemorrhage. 8 Higher levels of homocysteine, tissue factor, and decreased activity of tissue plasminogen activator factor and matrix metalloproteinases were observed among Introduction Cardiovascular diseases (CVDs) account for 31% of all deaths, that is, 17.9 million deaths per year. Tobacco use is among the greatest risk factors for CVD and accounts for 1 in 4 deaths due to CVDs. 1,2 In addition, the 10-year risk of death is doubled in smokers compared with nonsmokers, 3 and smoking is the most important cause of premature death. 4 Apart from the cardiovascular system, smoking affects other systems including respiratory, digestive, endocrine, and genitourinary systems. Interventions to increase smoking cessation are among the most cost-effective lifestyle modifications. The aim of this review was to discuss the risk of smoking and the potential increase of thrombotic risk related to smoking cessation. Smoking as a classic risk factor for cardiovascular diseases The prevalence of cigarette smoking in general population is decreasing 5 but smoking remains one of the most important modifiable

Risk Factors of New Cerebral Infarctions After Endovascular Treatment for Basilar Artery Stenosis Based on High-Resolution Magnetic Resonance Imaging

“…Another interpretation was that smokers with acute stroke were younger than non-smokers and had lower rates of complications, such as diabetes mellitus and hypertension. Similarly, in the era of endovascular treatment for cardiovascular diseases, the paradoxical effect of smoking was demonstrated in landmark clinical trials, where the short-term prognosis for smokers with acute cardiovascular diseases after mechanical thrombectomy was better than that for non-smokers (adjusted OR: 0.54, 95% CI: 0.38-0.76) (31,32). Furthermore, previous studies of a subgroup analysis of the International Carotid Stenting Study (ICSS) demonstrated a reduced incidence of 30day postoperative major adverse events in smokers compared with non-smokers (adjusted OR, 0.33; 95% CI, 0.13-0.85) (33).…”

“…First, the study data were limited due to the retrospective nature of the study. It was difficult to subdivide the smoking state of the patients into currently smoking and previously smoking without more details of smoking, however, it has been found that the devastating effects of tobacco smoking on vessels are lasting and do not subside easily after quitting (31). Several studies have reported better short-term outcomes in smokers, including previously and currently smoking compared with non-smokers (42).…”

Treatment Discontinuation in Patients With Muscle-Invasive Bladder Cancer Undergoing Chemoradiation

“…However, age was not associated with radiation discontinuation and there was no significant interaction between age and smoking status in the multivariable models. Therefore, the observed paradoxical association between smoking and radiation discontinuation is likely explained by the combination of difference in age in conjunction with a potential 'smoker's paradox' [15][16][17] in this population but this requires further investigation. Alongside validating the identified variables in our analysis, additional markers should be sought to help accurately guide who will likely finish CRT and should therefore undergo definitive treatment.…”

Aborted myocardial infarction in patients with ST-segment elevation myocardial infarction treated with mechanical reperfusion

“…At long -term follow -up, abMI was an independent factor that decreased the mortality risk (hazard ratio, 0.47; 95% CI, 0.3-0.75; P = 0.001) (TAblES 4 and 5). note is the smoker's paradox, which has been described in numerous papers [15][16][17][18][19] and associated with inconsistent results of analysis. In the GUSTO -I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) trial, smokers admitted to the hospital with ACS and treated with thrombolytics had a significantly lower rate of in -hospital and 30-day mortality than nonsmokers.…”

“…In the GUSTO -I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) trial, smokers admitted to the hospital with ACS and treated with thrombolytics had a significantly lower rate of in -hospital and 30-day mortality than nonsmokers. 18 Ramotowski et al 19 summarized the influence of smoking on cardiovascular disease development and the smoker's paradox. They hypothesized that hemostasis in smokers is modified, including changes in endothelial function, platetet activation, and fibrinolysis.…”