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Differences in the Effect of Cigarette Smoking on Endothelial Function in Chinese and White Adults

Kam S. Woo, MB, BS, MD, FRACP; Jacqui T.C. Robinson, RN; Ping Chook, MPhil, MD; Mark R. Adams, MBBS, FRACP; Gabriel Yip, MB, ChB, MRCP; Z.J. Mai, MD; Chris W.K. Lam, PhD; Keld E. Sorensen, MD; John E. Deanfield, MB, ChB, FRCP; and David S. Celermajer, MB, BS, PhD, FRACP
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Acknowledgments: The authors thank the following persons for technical support: Dr. Jane McCrohon and Ms. Robyn McCredie of Royal Prince Alfred Hospital; Mr. S. Ho of the Chinese University of Hong Kong; Drs. W.K. Lai and C.W. Xu of Pan Yu Hospital; Drs. X.Z. Zhan, C.X. Zhang, and J.Z. Feng of Guangdong Provincial Cardiovascular Institute; Dr. L.F. Xing of Shek Kei Village community health center; and Professor Z.S. Zheng of Sun Yat Sen University of Medical Sciences in Guangzhou. Grant Support: In part by grants from the National Heart Foundation of Australia, the Atherosclerosis Research Trust in Hong Kong and the Cardiac Research Fund of the Chinese University of Hong Kong. Ms. Robinson and Dr. Adams are supported by the National Heart Foundation of Australia, and Dr. Celermajer is supported by the Medical Foundation, University of Sydney. Acuson (Hong Kong) and Chindex Co. Ltd. in China provided the ultrasonography machine at Shek Kei Village. Requests for Reprints: David S. Celermajer, MB, BS, PhD, FRACP, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown 2050, Sydney, Australia. Current Author Addresses: Drs. Woo, Chook, and Yip: Department of Medicine, Prince of Wales Hospital, Shatin, NT, Hong Kong.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(5):372-375. doi:10.7326/0003-4819-127-5-199709010-00006
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Background: The prevalence of coronary artery disease in southern China is approximately one fifth that in “westernized” countries, even though approximately 70% of Chinese men smoke cigarettes and Chinese women have substantial passive exposure to cigarette smoke.

Objectives: Endothelial dysfunction is an early event in atherosclerosis and occurs in young white active and passive smokers; we compared endothelial physiology in healthy young Chinese and white smokers and nonsmokers.

Patients: 144 healthy adults who were 16 to 45 years of age: 72 Chinese persons in a village in southern China and 72 white persons in Australia and England who were matched for exposure to cigarette smoke. Each ethnic group comprised 36 controls (lifelong nonsmokers with no regular exposure to cigarette smoke; 16 men and 20 women) and 36 active or passive smokers (15 men and 21 women).

Measurements: Arterial endothelial function was tested with high-resolution external vascular ultrasonography, and brachial artery diameter was measured at rest, after flow increase (which causes endothelium-dependent dilatation), and after administration of sublingual nitroglycerin (an endothelium-independent dilator).

Results: Endothelium-dependent dilatation was similar in Chinese (7.9%) and white (8.4%) nonsmokers (P > 0.2). Among white persons, endothelium-dependent dilatation was lower in active or passive smokers (3.9%) than in nonsmokers (8.4%) (P < 0.001). Among Chinese persons, dilatation was not significantly lower in active or passive smokers (7.3%) than in nonsmokers (7.9%) (P > 0.2). Dilatation was higher in Chinese active or passive smokers (7.3%) than in white active or passive smokers (3.9%) (P < 0.001). Dilatation responses to nitroglycerin were similar in all groups (P = 0.17).

Conclusion: Young Chinese adults have less evidence of arterial endothelial dysfunction than young white adults with similar direct or indirect exposure to cigarette smoke.


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Figure 1.
Endothelium-dependent dilatation in Chinese and white nonsmokers and Chinese and white active or passive smokers.PP

Analysis of variance followed by pairwise comparisons showed that endothelium-dependent dilatation was significantly lower ( < 0.001) in the white active or passive smokers than in the white nonsmokers, Chinese active or passive smokers, and Chinese nonsmokers. This dilatation was similar among the latter three groups ( > 0.2). In each box plot, the bottom and top of the box represent the 25th percentile and the 75th percentile, respectively. The line across each box represents the median value, and the vertical lines encompass the entire range of values for each group of participants. Striped boxes represent Chinese participants; white boxes represent white participants.

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