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Unfavorable Effects of Passive Smoking on Aortic Function in Men

Christodoulos Stefanadis, MD; Charalambos Vlachopoulos, MD; Eleftherios Tsiamis, MD; Leonidas Diamantopoulos, MD; Konstantinos Toutouzas, MD; Nikos Giatrakos, MD; Sophia Vaina, MD; Dorothea Tsekoura, MD; and Pavlos Toutouzas, MD
[+] Article and Author Information

From Hippokration Hospital, University of Athens, Athens, Greece. Grant Support: By a grant from the Hellenic Heart Foundation. Requests for Reprints: Christodoulos Stefanadis, MD, 9 Tepeleniou str., Paleo Psychico, Athens 154 52, Greece. Current Author Addresses: Dr. Stefanadis: 9 Tepeleniou str., Paleo Psychico, Athens 154 52, Greece.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(6):426-434. doi:10.7326/0003-4819-128-6-199803150-00002
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Background: The aorta acts as both a conduit and an elastic buffering chamber that modulates left ventricular function and coronary blood flow. Previous studies have shown that active smoking has unfavorable effects on aortic elasticity.

Objective: To study the association between passive smoking and the elastic properties of the human aorta.

Design: Comparison of nonsmokers during passive smoking studies and smokers during active smoking or sham smoking studies.

Setting: Academic medical center.

Participants: 16 male nonsmokers were assigned to passive smoking studies, and 32 current, long-term, male smokers were randomly assigned to either active smoking (16 patients) or sham smoking (16 patients) studies.

Intervention: All participants underwent diagnostic catheterization. In the passive smoking group, environmental tobacco smoke was vented into an exposure chamber for 5 minutes (mean carbon monoxide level, 30 parts per million). Each participant in the active smoking group smoked one filtered cigarette (1.0 mg of nicotine) under standardized conditions within 5 minutes; each participant in the sham smoking group performed a similar pattern of inhalation with one unlit cigarette.

Measurements: Aortic elastic properties were studied by measuring the aortic pressure-diameter relation before and for 20 minutes after passive, active, or sham smoking. Instantaneous diameter of the thoracic aorta was measured with a high-fidelity ultrasonic dimension catheter. Instantaneous aortic pressure and diameter were measured at the same site.

Results: Both passive and active smoking were associated with changes in the aortic pressure-diameter relation (change in mean distensibility in the passive smoking group, from 2.02 to 1.59 × 10−6 cm2 · dyne−1 [for comparisons of time course between passive and sham smoking groups, P < 0.001]; change in mean distensibility in the active smoking group, from 2.08 to 1.51 × 10−6 cm2 · dyne (−1) [for comparisons of time course between active and sham smoking groups, P < 0.001]). These changes represent decreases of 21% and 27%, respectively. No changes in aortic elasticity were seen in the sham smoking group.

Conclusions: Both passive and active smoking are associated with an acute deterioration in the elastic properties of the aorta. This association between exposure to tobacco smoke and aortic elasticity indicates that aortic function deteriorates during passive or active smoking.

Figures

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Figure 1.
Study instruments.

Diameter-measuring device and cathetertip micromanometer are positioned at the same point of the thoracic aorta.

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Figure 2.
Representative examples of pressure-diameter loops of three participants (one each from the passive, active, and sham smoking groups).topmiddlebottom

Loops were obtained before and 4 minutes after the initiation of passive smoking for the participant in the passive smoking group ( ), before and 5 minutes after the initiation of active smoking for the participant in the active smoking group ( ), and before and 5 minutes after the initiation of sham smoking for the participant in the sham smoking group ( ). At baseline, 0.028 (1/35.465 [that is, 1/slope]) is the change in diameter (mm) per unit change in pressure (mm Hg). This measure of elasticity decreased to 0.017 (1/57.91) in the fourth minute of passive smoking. Moreover, the loop shifted to another hypothetical line of elasticity. Similar loop behavior was seen in all passive smokers and in the active smoking group. Five minutes after sham smoking began, the loop remained practically the same. (Regression lines are derived from one participant and one cardiac cycle; arrows indicate the regression lines to which the equations correspond).

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Figure 3.
Left.Right.[24]

Passive changes in aortic elastic properties are related to changes in blood pressure alone and are characterized by sliding of the pressure (P)-diameter (D) loop along the same hypothetical sigmoid line of elasticity. Active changes in elastic properties are related to changes in intrinsic elastic properties and are characterized by the shifting of the pressure-diameter loop to the left or right of the initial hypothetical sigmoid line of elasticity. If this shifting is associated with a counterclockwise rotation of the pressure-diameter loop, the new hypothetical line of elasticity has a steeper slope, denoting reduced elastic properties. Reproduced from Stefanadis and colleagues with permission.

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Figure 4.
Mean systolic and diastolic aortic pressure before, during, and after passive smoking (top), sham smoking (middle), and active smoking (bottom).PTable 2Table 2

values correspond to comparisons of the time course of these variables (the fifth column of for passive compared with sham smoking and the sixth column of for active compared with sham smoking). Error bars represent SDs.

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Figure 5.
Mean diastolic and systolic aortic diameter before, during, and after passive smoking (top), sham smoking (middle), and active smoking (bottom).PTable 2Table 2

values correspond to comparisons of the time course of these variables (the fifth column of for passive compared with sham smoking and the sixth column of for active compared with sham smoking). Error bars represent SDs.

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Figure 6.
Mean aortic distensibility before, during, and after passive smoking (top), sham smoking (middle), and active smoking (bottom).PTable 2Table 2

values correspond to comparisons of the time course of this variable (the fifth column of for passive compared with sham smoking and the sixth column of for active compared with sham smoking). Error bars represent SDs.

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