Prevention and Treatment of Tobacco Use: JACC Health Promotion Series

Initial experimentation with tobacco is associated with subsequent tobacco use patterns among youth in the United States

Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13-18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts.

Smoking prevalence among adults in China Mainland and their age of smoking initiation during adolescence: a national cross-sectional study

OBJECTIVES

This study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the disparities in sex, residence and age groups.

DESIGN

A cross-sectional study.

SETTING

The data were derived from a multistage sampling study conducted in 120 cities in China Mainland.

PARTICIPANTS

A total of 9963 participants aged ≥19 years were included.

PRIMARY OUTCOME MEASURES

Survival analysis was used to quantify the hazards of smoking initiation by a single year of age during adolescence, and the log-rank test was used to compare the hazard curves across subgroups.

RESULTS

The prevalence of current smoking among males and females was 27.7% and 2.0%, respectively, and 56.2% of current smokers began smoking at or before the age of 18. The hazard of smoking initiation during adolescence for females was less than 0.5%, and the hazard for males increased gradually before 14 years of age and increased sharply at age 15 (4.34%), then peaked at age 18 (6.24%). Males in rural experienced a higher hazard of smoking initiation than those in urban (χ2=5.35, p=0.02) and no such difference was found in females. By the age of 18 years, 11.7% of participants (1.8% for females and 23.4% for males) had ever smoked.

CONCLUSIONS

The prevalence of smoking among Chinese adults was lower than once reported. Males experienced higher hazards of smoking initiation at all ages than females. The hazard pattern suggests that the key focus for smoking prevention are males and adolescents aged 15-18 years, and future interventions should be delivered to the right target population at the appropriate time.

Lifestyle Medicine: An Antidote to Cardiovascular Diseases

Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.

Acute cardiovascular effects of 4th generation electronic cigarettes and combusted cigarettes: implications for harm reduction

The health consequences associated with using electronic cigarettes (ECs) are of great public interest because of their potential role in smoking cessation. In 110 participants, including 41 nonusers, 34 people who exclusively use ECs (EC group), and 35 people who smoke tobacco cigarettes (TCs) including 12 dual users (collectively called the TC-D group), the heart rate (HR), blood pressure (BP), and heart rate variability (HRV) were compared at baseline. People in the EC or the TC-D groups were also compared after using a 4th generation EC with or without nicotine, a TC with or without nicotine (TC-D group only), and a straw-control. Baseline HR, BP, and HRV parameters were not different among the EC, the TC-D, and nonuser groups. In people who exclusively use ECs, acute nicotine-EC use increased HR and BP, and produced changes in HRV patterns suggestive of increased cardiac sympathetic influence. In people in the TC-D group, BP increased similarly after acutely smoking a nicotine-TC or a nicotine-EC. However, the increase in HR was significantly greater after smoking a TC compared with the nicotine-EC despite similar acute increases in plasma nicotine. Overall, all exposures containing nicotine significantly increased HR and BP in both cohorts when compared with non-nicotine exposures. Since acute EC use 1) produces an abnormal HRV pattern associated with increased cardiac sympathetic tone in people who chronically use ECs, and 2) similar hemodynamic increases compared with acute TC smoking in people who chronically smoke TCs including dual users, the role of ECs as part of a harm reduction strategy is questioned.NEW & NOTEWORTHY We found that nicotine, not the non-nicotine constituents in tobacco cigarette (TC) or electronic cigarette (EC) emissions, may be the instigator of the acute, potentially adverse, changes in hemodynamics and heart rate variability (HRV) that were recorded several minutes after tobacco product use. Furthermore, acute EC use produced an abnormal HRV pattern associated with increased cardiac risk in people who chronically smoke ECs and produced similar hemodynamic increases compared with acute TC use in people who chronically smoke TCs, including people who are dual users.

Association Between the Frequency of Tooth Brushing and the Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis

Several epidemiological studies suggested that frequency of tooth brushing may be associated with cardiovascular disease (CVD) risk, but the results remain inconclusive. Therefore, the aim of this study was to synthesize frequency of tooth brushing and CVD risk using meta-analysis. Science Direct, PubMed, CINAHL, and OVID were searched through October 15, 2022. The random-effects model was used to quantitatively assess the combined risk estimation. In addition, we performed the sensitivity analysis to evaluate the robustness of the study results by excluding the included studies one by one. A total of 9 cohort studies containing 10 reports with 803,019 individuals were included in the meta-analysis. Pooled results showed that compared with the lowest brushing frequency, the highest brushing frequency (relative risk = 0.85, 95% confidence interval: 0.80-0.90) significantly reduced the risk of cardiovascular disease. There was moderate heterogeneity among included studies (P = .002, I2 = 65.4%). The exclusion of any one study did not materially change the combined risk estimates. Our meta-analysis supported the hypothesis that higher frequency of tooth brushing can reduce the risk of CVD, which may have important implications for conducting research on the prevention strategies of CVD.

The cost-effectiveness of improved brief interventions for tobacco cessation in Thailand

Background

This study estimated the cost-effectiveness of four strategies enhancing the quality and accessibility of Brief Intervention (BI) service for smoking cessation in Thailand during 2022-2030: (1) current-BI (status quo), (2) the effective-training standard-BI, (3) the current-BI plus the village health volunteers (VHV) mobilization, and (4) the effective-training BI plus VHV mobilization.

Methods

By interviewing five public health officers, nine healthcare professionals aiding these services, and fifteen BI service experts, we explored the status quo situation of the Thai smoking cessation service system, including main activities, their quantity assumptions, and activities' unit prices needed to operate the current cessation service system. Then, we modeled additional activities needed to implement the other three simulated scenarios. We estimated the costs and impacts of implementing these strategies over a nine-year operating horizon (2022-2030), covering 3 years of service system preparation and 6 years of full implementation. The modeled costs of these four strategies included intervention and program costs. The study focused on current smokers age 15 years or older. The assessed impact parameters encompassed smoking prevalence, deaths averted, and healthy life-years gained. An Incremental Cost-Effectiveness Analysis compared the four simulated strategies was employed. Data analysis was performed using the One Health Tool software, which the World Health Organization developed.

Results

The findings of this investigation reveal that all three intervention strategies exhibited cost-effectiveness compared to the prevailing status quo. Among these strategies, Strategy 2, enhancing BI service quality, emerged as the most efficient and efficacious option. Therefore, the expansion of quality services should be synergistically aligned with augmented training, service delivery optimization, and managerial enhancements.

Conclusion

This approach is particularly poised to enhance accessibility to and the efficacy of smoking cessation interventions across Thailand.

Technical efficiency and its determinants in regulating adolescents' coronavirus infection across Asian countries

The coronavirus pandemic, besides generating health distress, influences the socio-economic conditions of humankind. Every adolescent's lifestyle is affected by the virus. Healthy adolescents are not only key contributors to the forthcoming workforce but also a source of a country's human capital. The purpose of the article is to examine the efficacy of various Asian countries in regulating the spread of the coronavirus among adolescents. In addition to that, the paper also attempts to pinpoint the prime causes of the inefficiency of a country in regulating the same. The paper also examines the behavioural changes among adolescents across Asian countries in pre-and-post pandemic times. In this context, the study identifies the impact of adolescents' tobacco consumption, female political leadership, and accreditation on a country's efficacy to regulate adolescents' coronavirus infection. The study's empirical analysis covers twenty-one Asian countries. By using the Panel Stochastic Production Frontier, the study concludes that Kazakhstan is the most efficient country and Afghanistan is the least efficient country on the list. The inefficiency effects estimates conclude that adolescents' tobacco consumption decreases and good governance practices increase the efficiency of a country in regulating the spread of adolescent coronavirus infection. Additionally, the paper finds no significant behavioural changes among adolescents in pre-and-post pandemic times across Asian countries. The paper concludes with appropriate policy recommendations supported by empirical evidence. The paper also identifies its shortcomings and suggests potential future lines of inquiry.

Tobacco Use Patterns From Adolescence to Young Adulthood Among Latinx Youth From Rural Communities

PURPOSE

To examine patterns in adolescent and young adult tobacco use, comparing Latinx foreign-born children and children of foreign-born parents (i.e., children of immigrants(COI)) to Latinx US-born children of US-born parents (i.e., children of nonimmigrants,(CONI)) and to CONI White youth who grew up in small and rural towns.

METHODS

Data were from youth who lived in control communities that participated in a community-randomized trial of the Communities That Care prevention system. We compared Latinx CONI (n = 154) with Latinx COI (n = 316) and with non-Latinx White CONI (n = 918). We examined tobacco use in adolescence (any adolescent use, early onset, and chronic use) and young adulthood (any past-year tobacco use, any daily smoking, any nicotine dependence symptoms) with mixed-effects logistic regressions.

RESULTS

In adolescence, Latinx CONI had a higher prevalence of any and chronic tobacco use relative to Latinx COI, and of any and early onset tobacco use relative to non-Latinx White CONI. In young adulthood, Latinx CONI were more likely to report tobacco use in the past year, any symptoms of nicotine dependence, and daily smoking relative to Latinx COI; and more likely to report daily smoking relative to non-Latinx White CONI. Generation differences in young adult tobacco use were explained by chronic tobacco use in adolescence.

DISCUSSION

The study suggests targeting chronic tobacco use in adolescence to prevent disparities in tobacco outcomes among Latinx young adults from rural communities.

Nicotine induces macrophage pyroptosis via LINC01272/miR-515/KLF6 axis

Nicotine contributes to the causation of atherosclerosis, which the prominent cellular components are macrophages. Long non-coding RNAs (lncRNAs) play an important role in regulating cell functions such as cell proliferation, differentiation and programmed death. However, the function and mechanism of lncRNAs in nicotine-induced macrophage pyroptosis has not been reported. We screened the deferentially expressed lncRNAs of human carotid artery plaque (GSE97210) and verified them in nicotine-induced pyroptosis of macrophages. Results showed only LINC01272 was up-regulated in a dose-dependent manner in macrophages. The immunofluorescence staining result confirmed that interfering LINC01272 inhibited nicotine-induced macrophage pyroptosis. Through bioinformatics analysis, dual luciferase reporter gene assay and qPCR, we identified miR-515 was significantly negatively correlated with the expression of LINC01272, and KLF6 is the target gene of miR-515. Furthermore, our results demonstrated that LINC01272/miR-515/KLF6 axis meditated nicotine-induced macrophage pyroptosis. In addition, in human peripheral blood mononuclear cells of smoking populations, the expression of GSDMD-N, NLRP3, LINC01272 and KLF6 was significantly increased, while the level of miR-515 was reduced. This study confirmed that nicotine increases the expression of LINC01272 to competitively bind with miR-515 in macrophages, reducing the inhibitory effect of miR-515 on its target gene KLF6, which ultimately induces macrophage pyroptosis.

Patients' views on health promotion and disease prevention services provided by healthcare workers in a South African tertiary hospital

BACKGROUND

Patients' views and experiences in healthcare institutions provide a means of assessing the quality of services patients receive from healthcare workers (HCWs). However, the views of patients on the health promotion (HP) and disease prevention (DP) services offered by HCWs and the delivery mode have not been adequately studied.

AIM

This study assessed the views of patients on HP and DP services provided by various categories of HCWs.

SETTING

The study was conducted at a tertiary hospital in the Nelson Mandela Bay Municipality, South Africa.

METHOD

An exploratory cross-sectional study was conducted among 500 patients. The questionnaire elicited responses from patients regarding the HP and DP services received from the different cadres of HCWs at three different admission phases: pre-admission phase (PAP), admission phase (ADP), and post-admission phase (POP). Descriptive, bivariate, and multivariate analysis was conducted.

RESULTS

In the PAP, most patients (83.33%, n = 5; 87.85%, n = 217; and 76.14%, n = 150) seen by the rehabilitation health workers, medical doctors, and nurses respectively were empowered to manage their health. Patients attended to by nurses were 0.45 (95% CI 0.27-0.74) times less likely than those attended to by medical doctors to receive information that that will help them address the physical and environmental needs. In the ADP, patients attended to by nurses were less likely, compared to those attended to by medical doctors to be empowered to have good control over their health. In the POP, patients attended to by nurses are more likely to have their health behaviours change for better compared to those not seen by any HCW.

CONCLUSION

Patients attending tertiary hospital received greater HP and DP services during the PAP and ADP of patient care. Greatest influence for behavioural change of patients on HP and DP were achieved from the medical doctors, nurses and rehabilitation service staff. Improving structural factors may prove beneficial in enhancing patients' experience from all HCW groups and phases of patient care.

Behavioral and Metabolic Risk Factors for Noncommunicable Diseases among Population in the Republic of Srpska (Bosnia and Herzegovina)

Noncommunicable diseases (NCDs) are the major cause of death worldwide, and they are attributable to genetic and physiological determinants, behavioral risk factors and environmental impacts. The aim of this study is to assess behavioral risk factors for metabolic disease using demographic and social-economic aspects of the population characterized by risk factors, and to investigate relations among lifestyle risk factors (alcohol consumption, tobacco use, physical inactivity, intake of vitamins, fruits and vegetables) that are responsible for the majority of NCD deaths in the Republic of Srpska's (RS's) population. This is a cross-sectional study based on the analysis of a survey conducted among 2311 adult (≥18 years) persons (54.0% women, and 46.0% men). The statistical analysis was carried out by using Cramer's V values, clustering, logistic regression (binomial, multinomial and ordinal), a chi-square test and odds ratios. In the case of logistic regression, we provide the prediction accuracy in percentages. A significant statistical correlation between demographic characteristics (gender and age) and risk factors was observed. The highest difference according to gender was observed in alcohol consumption (odds ratio (OR) = 2.705, confidence interval (95% CI) = 2.206-3.317), particularly in frequent consumption (OR = 3.164, 95% CI = 2.664-3.758). The highest prevalence of high blood pressure was registered in the elderly (66.5%); the same holds for hypertension (44.3%). Additionally, physical inactivity was one of the most common risk factors (33.4% physically inactive respondents). A significant presence of risk factors was confirmed among the RS population, with higher involvement of metabolic risk factors among the older population, while the prevalence of behavioral factors was related to younger age groups, particularly in the case of alcohol consumption and smoking. A low level of preventive awareness was observed among the younger population. Therefore, prevention is one of the most important instruments related to decreasing NCD risk factors in the RS population.

Child psychological well-being and adult health behavior and body mass index

OBJECTIVE

Psychological well-being (PWB) is linked with health behaviors among adults, but it is unclear if childhood PWB prospectively predicts healthy adulthood biobehavioral profiles. Such evidence may identify developmental windows for establishing positive health trajectories across the lifespan. Using data spanning 30 years, we investigated whether PWB at age 11 was associated with health behaviors and body mass index (BMI) at ages 33 and 42. We hypothesized children with higher versus lower PWB would engage in healthier behaviors, have lower BMI in adulthood, and be more likely to maintain optimal levels over time.

METHOD

Data were from 4,728 participants of the 1958 National Child Development Study. At age 11, participants wrote an essay about how they imagined their lives at age 25. Two judges rated each essay for multiple facets of PWB, which were combined into a summary score (Cronbach's α = .91). At ages 33 and 42, participants reported on cigarette smoking, physical activity, and diet; BMI was also assessed. Regression models evaluated PWB's association with adult outcomes at each follow-up, and with patterns over time.

RESULTS

Child PWB was unassociated with smoking in adulthood. However, greater child PWB was associated with healthier adult physical activity, diet, and BMI when adjusting for sex. Child PWB was associated with the likelihood of maintaining optimal BMI in adulthood, but not with maintaining healthy behaviors. Some associations were not independent of other childhood covariates.

CONCLUSIONS

Early life lays the foundation for lifelong health. Childhood PWB may contribute to healthier behaviors and BMI in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of tobacco product use on oral health and the role of oral healthcare providers in cessation: A narrative review

Tobacco use has detrimental effects on health, including oral health. The emergence and increasing popularity of newer tobacco and nicotine products make tobacco use one of the major public health problems in the world. Tobacco use increases the risk of oral diseases such as oral cancer, oral mucosal lesions, periodontal disease, and dental caries, among many other oral diseases and conditions. The dental office is an excellent venue for providing cessation intervention. However, there is a lack of knowledge and training in tobacco use prevention among dental professionals. More efforts are needed for smoking cessation interventions in the dental office. Smoking cessation interventions provided by oral healthcare providers include brief educational, behavioral, and pharmacological interventions. This review provides an overview of the ill effects of tobacco use on oral health and the role of oral healthcare providers in managing and preventing tobacco dependence.

Exploring Multilevel Workplace Tobacco Control Interventions: A Scoping Review

BACKGROUND

The workplace provides a unique opportunity to intervene on tobacco use, by implementing multilevel interventions engaging diverse employees. Using the social ecological model (SEM), this scoping review aimed to synthesize descriptions of multilevel workplace tobacco control programs to create a health equity informed framework for intervention planning.

METHODS

Multiple databases were searched for articles published from January 2010 to December 2020 meeting inclusion criteria (i.e., discussed multilevel tobacco cessation interventions that intervene, target, or incorporate two or more levels of influence, and one of the levels must be the workplace). Articles were screened by two independent researchers and included if they discussed multilevel tobacco cessation interventions that intervened, targeted, or incorporated two or more levels of influence. To integrate the extracted information into the SEM, we utilized the McLeroy et al. model and definitions to describe potential multilevel interventions and their determinants.

RESULTS

Nine articles were included in this review. No studies intervened across all five levels (individual, interpersonal, institutional, community, and policy), and the most common levels of intervention were individual (e.g., individual counseling), interpersonal (e.g., group therapy), and institutional (e.g., interventions during work hours). Participation rates varied by key social determinants of health (SDOHs) such as age, gender, education and income. Barriers including cost and sustainability influenced successful implementation, while leadership endorsement and accessibility facilitated successful implementation.

DISCUSSION/APPLICATION TO PRACTICE

Multilevel interventions targeting at least two SEM levels may reduce persistent health inequities if they address how SDOHs influence individual health behaviors. Employee characteristics impacted the success of tobacco cessation interventions, but more research is needed to understand the barriers and facilitators related to workplace characteristics.

Blood Pressure and Inflammation Parameter in the Healthy-Overweight Smoker in Yogyakarta

BACKGROUND: The number of smokers in rural Indonesia is alarming. Overweight and smoking are the risk factor for hypertension, diabetes mellitus, and cancer. Cigarette smoke and overweight elevated oxidative stress and affected the blood pressure and inflammation response. However, the relationship between blood pressure and the response to inflammation in overweight-healthy smokers was unclear. AIM: We have conducted a preliminary study to determine the difference in blood pressure and inflammatory parameters on overweight and non-overweight in healthy smokers. METHODS: We have conducted a study with a cross-sectional design. Thirty-seven healthy smokers are the number of subjects who participated in our study; 20 were overweight, and the other 17 subjects were non-overweight. The smokers consumed 5–12 cigarettes/day regularly for at least 5 years. Furthermore, smokers were diagnosed in healthy condition by the doctor in the primary health care. Blood was drawn from the cubital vein by professionals. Hematology and inflammatory parameters were examined using a hematology analyzer and an ELISA method. We used the t-test to determine the mean difference in parameters between groups. RESULTS: The study of 37 healthy volunteers who smoked showed that overweight status had higher blood pressure and IL-1 levels than the non-overweight. There was a difference in mean systolic and diastolic blood pressure and IL-1 levels between the overweight and non-overweight groups (p < 0.05). The overweight status was in accordance with the mean of BMI and body weight (p < 0.05). There were no differences in cholesterol, triglyceride levels and hemogram profiles, and other cytokines between the two groups (p > 0.05). CONCLUSION: We concluded that the overweight group had higher blood pressure and IL-1 levels than the non-overweight group of healthy smokers.

The association of genetic susceptibility to smoking with cardiovascular disease mortality and the benefits of adhering to a DASH diet: The Singapore Chinese Health Study

BACKGROUND

Understanding the genetic predisposition to cardiovascular disease (CVD) may help to improve clinical intervention strategies. Lifestyle factors, such as diet, may differ among ethnic groups and may, in turn, modify individuals' risks to diseases.

OBJECTIVES

We examined the genetic predisposition to ever smoking in relation to CVD mortality and assessed whether such an association could be modified by dietary intake.

METHODS

A total of 23,760 Chinese adults from the Singapore Chinese Heath Study who were free of cancer and CVD at recruitment (1993-1998) were included in the study. A weighted genetic risk score (wGRS) was calculated to define the genetically determined regular smoking behavior (never or ever). Multivariable-adjusted Cox regression models were used to assess the association between the wGRS and CVD mortality. We also conducted a 1-sample Mendelian randomization analysis for ever smoking and CVD mortality.

RESULTS

Over a mean of 22.6 years of follow-up, 2301 CVD deaths were identified. A genetic predisposition to ever smoking was significantly associated with CVD mortality; the multivariable-adjusted HR of CVD mortality was 1.07 (95% CI: 1.03-1.12), with a per-SD increment in the wGRS. However, the Mendelian randomization analysis did not support a causal relationship between ever smoking and CVD mortality (OR, 1.13; 95% CI: 0.87-1.45). Additionally, the Dietary Approaches to Stop Hypertension (DASH) score significantly modified the association between the smoking wGRS and CVD mortality; the association between a genetic predisposition to smoking and CVD mortality was only observed among individuals with a low DASH score (P-interaction = 0.004).

CONCLUSIONS

A genetic predisposition to smoking was associated with CVD mortality in the Chinese population. In addition, we detected a significant interaction showing higher CVD mortality related to genetically determined smoking among those with lower DASH scores.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Training Tobacco Treatment Specialists through Virtual Asynchronous Learning

Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.

Treatment of Tobacco Smoking: A Review

IMPORTANCE

More deaths in the US are attributed to cigarette smoking each year than to any other preventable cause. Approximately 34 million people and an estimated 14% of adults in the US smoke cigarettes. If they stopped smoking, they could reduce their risk of tobacco-related morbidity and mortality and potentially gain up to 10 years of life.

OBSERVATIONS

Tobacco smoking is a chronic disorder maintained by physical nicotine dependence and learned behaviors. Approximately 70% of people who smoke cigarettes want to quit smoking. However, individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence. Both behavioral counseling and pharmacotherapy while using nicotine replacement therapy (NRT) products, varenicline, or bupropion are effective treatments when used individually, but they are most effective when combined. In a meta-analysis including 19 488 people who smoked cigarettes, the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. The EAGLES trial, a randomized double-blind clinical trial of 8144 people who smoked, directly compared the efficacy and safety of varenicline, bupropion, nicotine patch, and placebo and found a significantly higher 6-month quit rate for varenicline (21.8%) than for bupropion (16.2%) and the nicotine patch (15.7%). Each therapy was more effective than placebo (9.4%). Combining a nicotine patch with other NRT products is more effective than use of a single NRT product. Combining drugs with different mechanisms of action, such as varenicline and NRT, has increased quit rates in some studies compared with use of a single product. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings.

CONCLUSIONS AND RELEVANCE

Approximately 34 million people in the US smoke cigarettes and could potentially gain up to a decade of life expectancy by stopping smoking. First-line therapy should include both pharmacotherapy and behavioral support, with varenicline or combination NRT as preferred initial interventions.

Life-long prevention of cardiovascular disease. Part II: childhood and adolescence

In recent years, researchers have increasingly noted that the development and health of cardiovascular system is influenced by both traditional risk factors (RF) and other determinants of human exposome — a combination of factors of the external and internal environment that affect genetics and epigenetics, as a result of which, one or another (more or less healthy) phenotype is formed. Exposome components have a continuous effect throughout all periods of life. Many RFs have a cumulative effect, and therefore it is important to start prevention of cardiovascular diseases (CVDs) as early as possible. The aim of this review was to consider various aspects of CVD prevention in childhood and adolescence. These periods are critical for the development of most behavioral habits, which maintain throughout life. Leading by personal example by parents and the immediate environment plays a paramount role in healthy lifestyle inclusion of children and adolescents. Targeted programs in kindergartens and schools aim at improving health literacy, early detection and timely changing traditional and non-traditional CVD RFs, diagnosis of genetic diseases involving the heart and blood vessels, prevention of sudden cardiac death are also important methods of CVD prevention in childhood and adolescence. Measures of population-based prevention are of great importance, including monitoring of advertising and media content, statutory ban of alcohol and tobacco sale, and the formation of healthy lifestyle.

The effects of quercetin on nicotine-induced reward effects in mice

OBJECTIVES

Tobacco smoking remains the primary cause of preventable mortality and morbidity in the world. The complexity of the nicotine dependency process included the withdrawal effect that triggers recurrence being the main problem. Quercetin, known as an antioxidant, binds free radicals and modulates endogenous antioxidants through Nrf2 activations is expected as a potential agent to reduce the risk of nicotine dependence. This research aims to evaluate quercetin's effects on reducing the risk of nicotine addiction.

METHODS

Conditioned Place Preference (CPP) with a biased design was used to evaluate nicotine's reward effects in male Balb/C mice. Preconditioning test was performed on day 1; conditioning test was done twice daily on day 2-4 by administering quercetin (i.p.) 50 mg/kg along with nicotine (s.c.) 0.5 mg/kg or Cigarette Smoke Extract (CSE) (s.c.) contained nicotine 0.5 mg/kg; and postconditioning test was performed on day 5 continue with extinction test on day 6, 8, 10, 12, and reinstatement test on day 13. The duration spent in each compartment was recorded and analyzed.

RESULTS

Nicotine 0.5 mg/kg and CSE 0.5 mg/kg significantly induced reward effects (p<0.05). There was no decrease of reward effect during the extinction-reinstatement stage of the postconditioning phase (p>0.05), while quercetin 50 mg/kg both induced along with nicotine or CSE was able to inhibit the reward effect of nicotine (p>0.05).

CONCLUSIONS

Quercetin reduced the risk of nicotine dependence and has a potential effect to use as a therapy for nicotine dependence, especially as a preventive agent.

Impact of chronic use of heat-not-burn cigarettes on oxidative stress, endothelial dysfunction and platelet activation: the SUR-VAPES Chronic Study

Tobacco habit still represents the leading preventable cause of morbidity and mortality worldwide. Heat-not-burn cigarettes (HNBCs) are considered as an alternative to traditional combustion cigarettes (TCCs) due to the lack of combustion and the absence of combustion-related specific toxicants. The aim of this observational study was to assess the effect of HNBC on endothelial function, oxidative stress and platelet activation in chronic adult TCC smokers and HNBC users. The results showed that both HNBC and TCC display an adverse phenotype in terms of endothelial function, oxidative stress and platelet activation. Future randomised studies are strongly warranted to confirm these data.

Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists

Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.

Vaping and cardiac disease

Tobacco cigarette smoking is the most prevalent reversible risk factor for cardiovascular disease in the USA. Electronic cigarettes, invented as an alternative nicotine source for smokers unable or unwilling to stop smoking, have gained skyrocketing popularity, but their cardiovascular risk remains uncertain. Although data recently analysed in a Cochran report do support their superior effectiveness to other forms of nicotine replacement therapies for smoking cessation, electronic cigarettes are also frequently used by non-smokers-especially high school students. There are no long-term outcome studies on the cardiovascular risk of vaping electronic cigarettes, but the effects of electronic cigarettes on known risk factors for cardiovascular disease, including neurohumoural activation, oxidative stress and inflammation, endothelial function and thrombosis, have been studied. In this review, we summarise evidence in humans that supports the notion that while electronic cigarettes may be less harmful than traditional cigarettes, they are not harmless. Additionally, the increasing popularity of vaping marijuana with its unknown cardiovascular risks as well as the outbreak in 2019 of EVALI (electronic cigarette, or vaping, product use-associated lung injury) related to bootlegged vaping products raise further concerns. Before physicians can confidently advise their smoking patients about the role of electronic cigarettes as a means of smoking cessation to lower cardiovascular risk, improved regulation and quality control is necessary.

Health Equity Among Black Women in the United States

Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved.

Vaping Instead of Cigarette Smoking: A Panacea or Just Another Form of Cardiovascular Risk?

Since 2007, the electronic cigarette (EC), with its increasingly diverse array of device options, has gained popularity both among long-term tobacco cigarette (TC) smokers and among never-smoking youth. The absence of a number of known toxic by-products of TC smoking has helped cultivate the perception that ECs are healthy. However, an expanding literature has provided concerning evidence that a number of EC constituents, including nicotine, and their thermal degradation by-products may have adverse effects, including cardiovascular effects. In this review, we discuss the cardiovascular risks associated with EC vaping and compare this risk profile with TC smoking. Acknowledging the dynamic nature of EC vaping, we will focus on the latest developments, including the introduction of the pod-like device, which is the most popular EC device used today. We discuss the implications of a new, unique, nicotine chemistry that mimics the efficient and addictive nicotine delivery of TCs. Furthermore, we touch on the outbreak of the lethal lung disease associated with ECs, which exposed the lack of quality control in the EC industry. Along the way, we will identify the limitations of current knowledge and provide suggestions for future research. Overall, we conclude that although ECs may once have held promise as part of a harm-reduction strategy in people who smoke lethal TCs, this role has been largely offset by the unconscionable marketing to our youth, in addition to a failure of regulation and enforcement, leading to significant harm, especially in never-smokers who use them.

Challenges in coronary heart disease prevention - experiences from a long-term follow-up study in Norway

Objective. To determine longitudinal changes in lifestyle behaviour and lipid management in a chronic coronary heart disease (CHD) population. Design. A multi-centre cohort study consecutively included 1127 patients at baseline in 2014-2015, on average 16 months after a CHD event. Data were collected from hospital records, a questionnaire and clinical examination. Seven hundred and seven of 1021 eligible patients participated in a questionnaire-based follow-up in 2019. Data were analysed with univariate statistics. Results. After a mean follow-up of 4.7 years (SD 0.4) from baseline, the percentage of current smokers (15% versus 16%), obesity (23% versus 25%) and clinically significant symptoms of anxiety (21% versus 17%) and depression (13% versus 14%) remained unchanged, whereas the proportion with low physical activity increased from 53% to 58% (p < .001). The proportions with reduced physical activity level were similar in patients over and under 70 years of age. Most patients were still taking statins (94% versus 92%) and more patients used high-intensity statin (49% versus 54%, p < .001) and ezetimibe (5% versus 15%, p < .001) at follow-up. 73% reported ≥1 primary-care consultation(s) for CHD during the last year while 27% reported no such follow-up. There were more smokers among participants not attending primary-care consultations compared to those attending (19% versus 14%, p = .026). No differences were found for other risk factors. Conclusions. We found persistent suboptimal risk factor control in coronary outpatients during long-term follow-up. Closer follow-up and intensified risk management including lifestyle and psychological health are needed to improved secondary prevention and outcome of CHD. Trial registration: Registered at ClinicalTrials.gov: NCT02309255.Registered at 5 December 2014, registered retrospectively.

Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes

Tobacco smoking is a leading cause of non-communicable disease globally and is a major risk factor for cardiovascular disease (CVD) and lung disease. Importantly, recent data by the World Health Organizations (WHO) indicate that in the last two decades global tobacco use has significantly dropped, which was largely driven by decreased numbers of female smokers. Despite such advances, the use of e-cigarettes and waterpipes (shisha, hookah, narghile) is an emerging trend, especially among younger generations. There is growing body of evidence that e-cigarettes are not a harm-free alternative to tobacco cigarettes and there is considerable debate as to whether e-cigarettes are saving smokers or generating new addicts. Here, we provide an updated overview of the impact of tobacco/waterpipe (shisha) smoking and e-cigarette vaping on endothelial function, a biomarker for early, subclinical, atherosclerosis from human and animal studies. Also their emerging adverse effects on the proteome, transcriptome, epigenome, microbiome, and the circadian clock are summarized. We briefly discuss heat-not-burn tobacco products and their cardiovascular health effects. We discuss the impact of the toxic constituents of these products on endothelial function and subsequent CVD and we also provide an update on current recommendations, regulation and advertising with focus on the USA and Europe. As outlined by the WHO, tobacco cigarette, waterpipe, and e-cigarette smoking/vaping may contribute to an increased burden of symptoms due to coronavirus disease 2019 (COVID-19) and to severe health consequences.

Could E-cigarette vaping contribute to heart disease?

INTRODUCTION

E-cigarettes have become a controversial topic. While their benefits are questioned by the scientific community, a part of the medical profession is still supporting them as an effective harm reduction tool for smoking cessation. The impact of E-cigarettes on the cardiovascular system is still elusive.

AREAS COVERED

We assessed results from animal, pre(clinical), and epidemiological studies to critically evaluate and synthesize evidence relevant to the cardiovascular effects of E-cigarettes. Animal studies have demonstrated that E-cigarette vapor exposure can cause endothelial and cardiac dysfunction. However, there have also been reports on the less harmful effects of E-cigarette vapor exposure in comparison to classical tobacco cigarettes. Measurements of flow-mediated dilation in acute human exposure settings have mostly demonstrated that E-cigarettes cause vascular endothelial dysfunction. Epidemiological studies have shown that E-cigarette use is associated with an increased risk for cardiovascular disease, although switching from classical tobacco cigarettes to E-cigarettes can have beneficial cardiovascular effects. Misinterpretation of scientific data by activists on either side is another problem.

EXPERT OPINION

In conclusion, we need more and better (pre)clinical data comparing the health effects of E-cigarette vaping as compared with tobacco cigarette smoking, in order to counsel the legislation for better health policies.

Acute and chronic sympathomimetic effects of e-cigarette and tobacco cigarette smoking: role of nicotine and non-nicotine constituents

Electronic cigarettes (ECs) and tobacco cigarettes (TCs) both release nicotine, a sympathomimetic drug. We hypothesized that baseline heart rate variability (HRV) and hemodynamics would be similar in chronic EC and TC smokers and that after acute EC use, changes in HRV and hemodynamics would be attributable to nicotine, not non-nicotine, constituents in EC aerosol. In 100 smokers, including 58 chronic EC users and 42 TC smokers, baseline HRV and hemodynamics [blood pressure (BP) and heart rate (HR)] were compared. To isolate the acute effects of nicotine vs. non-nicotine constituents in EC aerosol, we compared changes in HRV, BP, and HR in EC users after using an EC with nicotine (ECN), EC without nicotine (EC0), nicotine inhaler (NI), or sham vaping (control). Outcomes were also compared with TC smokers after smoking one TC. Baseline HRV and hemodynamics were not different in chronic EC users and TC smokers. In EC users, BP and HR, but not HRV outcomes, increased only after using the ECN, consistent with a nicotine effect on BP and HR. Similarly, in TC smokers, BP and HR but not HRV outcomes increased after smoking one TC. Despite a similar increase in nicotine, the hemodynamic increases were significantly greater after TC smokers smoked one TC compared with the increases after EC users used the ECN. In conclusion, chronic EC and TC smokers exhibit a similar pattern of baseline HRV. Acute increases in BP and HR in EC users are attributable to nicotine, not non-nicotine, constituents in EC aerosol. The greater acute pressor effects after TC compared with ECN may be attributable to non-nicotine, combusted constituents in TC smoke.NEW & NOTEWORTHY Chronic electronic cigarette (EC) users and tobacco cigarette (TC) smokers exhibit a similar level of sympathetic nerve activity as estimated by heart rate variability. Acute increases in blood pressure (BP) and heart rate in EC users are attribute to nicotine, not non-nicotine, constituents in EC aerosol. Acute TC smoking increased BP significantly more than acute EC use, despite similar increases in plasma nicotine, suggestive of additional adverse vascular effects attributable to combusted, non-nicotine constituents in TC smoke.

Receipt and predictors of smoking cessation pharmacotherapy among veterans with and without HIV

Smoking is highly prevalent among people living with HIV (PLWH) and increases cardiovascular risk. Pharmacotherapies such as nicotine replacement therapy (NRT), bupropion, and varenicline help to reduce smoking, though rates of receipt among PLWH compared with HIV-uninfected persons are unknown. Among 814 PLWH and 908 uninfected patients enrolled in the Veterans Aging Cohort Study (2012-2017) who reported current smoking, we used marginal multivariable log-linear regression models to estimate adjusted relative risks (ARR) of receiving pharmacotherapy by HIV status. We also assessed patient-level factors associated with pharmacotherapy receipt within each group. In multivariable analyses, receipt of NRT was less likely among PLWH relative to uninfected participants (ARR 0.77, 95% CI 0.67, 0.89). In both populations, documented mental health disorders and contemplation to quit were associated with greater likelihood of receiving pharmacotherapy. Further research is needed to explore potential treatment disparities.

Scalar-on-function regression for predicting distal outcomes from intensively gathered longitudinal data: Interpretability for applied scientists

Researchers are sometimes interested in predicting a distal or external outcome (such as smoking cessation at follow-up) from the trajectory of an intensively recorded longitudinal variable (such as urge to smoke). This can be done in a semiparametric way via scalar-on-function regression. However, the resulting fitted coefficient regression function requires special care for correct interpretation, as it represents the joint relationship of time points to the outcome, rather than a marginal or cross-sectional relationship. We provide practical guidelines, based on experience with scientific applications, for helping practitioners interpret their results and illustrate these ideas using data from a smoking cessation study.

Primary prevention of ischaemic heart disease: populations, individuals, and health professionals

Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.

The Effects of Transdermal Nicotine Patches on the Cardiorespiratory and Lactate Responses During Exercise from Light to Moderate Intensity: Implications for Exercise Prescription during Smoking Cessation

Background and objectives: Exercise can help ease withdrawal symptoms of smokers. However, there is little information about the physiological responses, such as cardiorespiratory and lactate (La) responses, during exercise from light to moderate intensity combined with transdermal nicotine patches (TNPs) in smokers. This study aimed to investigate the effect of TNPs on the cardiorespiratory and La responses during exercise at light to moderate intensity. Materials and Methods: Fourteen young men (8 non-smokers, 6 current smokers) aged 20 to 26 years participated in this study. They performed an incremental graded submaximal exercise test using an electromagnetic cycle ergometer set from 30 to 210 W with (TNP condition) or without a TNP (control condition) in a random order. The TNP was applied to the left arm 8–10 h prior to starting the exercise to achieve the peak level of blood nicotine concentration. Heart rate (HR), rate of perceived exertion (RPE), oxygen consumption (VO₂), ventilation (VE), and blood La at rest and during exercise were measured and analyzed. Results: The HR at rest was significantly higher in the TNP condition than in the control condition (TNP; 74.7 ± 13.8 bpm, control; 65.3 ± 10.8 bpm, p < 0.001). There was no interaction (condition × exercise intensity) between any of the variables, and VO₂, VE, RPE, and La during exercise were not significantly different between the conditions. However, HR during exercise was 6.7 bpm higher on average in the TNP condition. Conclusions: The HR during exercise was greater at light to moderate intensity with a TNP. Our study results will guide clinicians or health professionals when prescribing exercise programs combined with TNPs for healthy young smokers.

Electronic cigarettes and cardiovascular health: what do we know so far?

While tobacco cigarette (TC) smoking has continued to drop to all-time lows, the use of electronic cigarettes (ECs), introduced in the US in 2007, has been rising dramatically, especially among youth. In EC emissions, nicotine is the major biologically active element, while levels of carcinogens and harmful combustion products that typify TC smoke are very low or even undetectable. TCs cause cardiovascular harm by activation of inflammatory pathways and oxidative damage, leading to atherogenesis and thrombosis, as well as through sympathetic activation triggering ischemia and arrhythmia. While ECs are generally believed to be safer than TCs, there remain many uncertainties regarding the overall cardiovascular health effects of EC usage. In this review, we discuss the various components of EC smoke and review the potential mechanisms of cardiovascular injury caused by EC use. We also discuss the controversy regarding the increasing epidemic of youth EC use weighed against the use of ECs as a smoking-cessation aid.

2019 Recommendations for reducing tobacco consumption in the Portuguese-speaking countries

After several decades of initiatives at international and national level inspired by the World Health Organization, tobacco consumption is still the second leading cause of death in the world and the leading cause of premature death and disability, as a result of various types of cancer and pulmonary, cerebrovascular and cardiovascular disease. Tobacco consumption is also an important public health issue in Portuguese-speaking countries, which fully justifies the launch and implementation of these 2019 recommendations for reducing tobacco consumption in Portuguese-speaking countries by the Federation of Portuguese Language Cardiology Societies. This position statement reviews recent changes in and the present epidemiology of tobacco consumption in the Portuguese-speaking countries, discusses the negative health impact of new forms of tobacco consumption, and addresses available prevention and drug treatment strategies. Eliminating smoking requires a coordinated effort between various national and international bodies, with a policy approach in each country focusing on laws, education campaigns for primary prevention aimed at to the general public, particularly to encourage young people not to start smoking, and a health system approach to help smokers quit smoking permanently by a combination of drug treatment and cognitive behavioral therapy. The aim is to control the only cardiovascular risk factor that can be completely eliminated. This position statement aims to alert health professionals to the need to approach the subject of smoking cessation with patients and their families during hospitalizations and outpatient consultations, and to provide them with up-to-date knowledge on how to quit smoking and maintain control of this risk factor in the long term.

The effect of glucagon-like peptide-1 (GLP-1) receptor agonists on substance use disorder (SUD)-related behavioural effects of drugs and alcohol: A systematic review

Glucagon-like-peptide-1 (GLP-1)-receptor agonists have been proposed as putative treatment for substance use disorders (SUD). The objective of this systematic review is to characterize the effects of GLP-1-receptor agonists on SUD-related behavioural effects of drugs, nicotine, and alcohol. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search was performed in PubMed and EMBASE on June 16, 2018. The inclusion criteria were primary studies investigating the use of GLP-1-receptor agonists on behavioural endpoints related to SUD. Seventeen studies were included, investigating the effect of the GLP-1-receptor agonists exendin-4, fluoro-exendin-4, liraglutide, AC3174 and GLP-1 (7-36) on SUD-related behavioural effects of ethanol, cocaine, amphetamine, and/or nicotine. All studies used rodents as subjects. Nine of the studies dealt with ethanol, six with cocaine, two with amphetamine, and two with nicotine. Most studies investigated acute treatment effects, finding a significant effect in all but one experiment. A few studies investigated more chronic effects on ethanol. All the studies reported sustained effects. Eleven studies tested more than one dose, finding a dose-related response in ten out of thirteen experiments. Six studies report a central effect through intra-cerebral administration or by using mice in which the central GLP-1-receptors had been inactivated. In conclusion, a solid body of evidence documents acute effects of GLP-1-receptor agonist treatment on behavioural effects of alcohol, nicotine, amphetamine and cocaine. Documentation of effect of more chronic GLP-1-receptor stimulation on these behaviours is limited.

Inflammation and Thrombosis in Coronary Atherosclerosis: Pathophysiologic Mechanisms and Clinical Correlations

Inflammation and thrombosis are interrelated processes that are important in the pathogenesis of atherothrombosis. Inflammation is important in both the early and late stages of atherosclerosis, and it involves elements of immune system activation. Low density lipoprotein (LDL) is an important initiator but is not the only one. LDL enters the cell membrane, is modified, and sets into motion a series of events that stimulate the ingress of specific proinflammatory mononuclear cells through the vessel wall. These cells imbibe lipids and form foam cells. Proinflammatory mediators secreted by these cells can eventually lead to intimal thickening and lipid accumulation, forming atherosclerotic plaques. A complex interplay between inflammation, platelet function, and hypercoagulability is a major contributor to the progression from stable to unstable plaque and an acute coronary event. In the later stages of atherosclerosis, inflammatory cells can destabilise certain lipid-rich lesions contributing to symptomatic coronary thrombosis. Thus, thrombosis is the final common pathway for most atherosclerotic complications. Thrombi may also contribute to the asymptomatic rapid progression of atherosclerotic lesions. While antithrombotic agents are important in the treatment of acute coronary syndromes, as well as preventive therapy in high-risk primary prevention and in secondary prevention, the role of specific anti-inflammatory agents is not currently established. If such therapies are to become routine, these anti-inflammatory drugs must significantly reduce events while not adversely affecting a patient’s natural immunity to an extent that erases any potential benefit. This article reviews these two processes with an emphasis on coronary atherosclerosis and its sequelae.

Editor-in-Chief's Top Picks From 2018

Each week, I record audio summaries for every article in JACC, as well as an issue summary. Although this process is quite time-consuming, I have become familiar with every paper that we publish. Thus, I have personally selected the top 100 papers (both Original Investigations and Review Articles) from 15 distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, CV Medicine & Society, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-100).