Risk of Myocardial Infarction and Stroke in Smokers Is Related to Plasma Levels of Inflammation-Sensitive Proteins

Water pipe smoking and stroke: A systematic review and meta-analysis

OBJECTIVE

Despite the damaging effects of water pipe on physical health, there is little information about the potential harmful effects of this tobacco on stroke. This study aims to investigate the relationship between water pipe smoking and stroke.

METHOD

A systematic review was conducted including Ovid SP, Embase, Pubmed, Web of Science, Scopus, and Google Scholar databases with focus on cohort, case-control, and cross-sectional studies. We reviewed all studies reporting on water pipe smoking and stroke. The funnel plot and the Egger regression test were used to assess publication bias.

RESULTS

In the four eligible studies, there were a total of 2759 participants that 555 patients had at least once experienced stroke. Meta-analysis revealed positive association between water pipe smoking and stroke with pooled adjusted OR 2.79 (95% CI: 1.74-3.84;I 2 = 0 , p = . 741 ${I^2}\; = \;\;0,{\mathrm{\;}}p\;\; = {\mathrm{\;\;}}.741$ ) and the funnel plot shows asymmetry publication bias.

CONCLUSIONS

We found a higher effect of water pipe smoking on stroke compared to cigarette smoking and concluded that water pipe increases the risk of stroke by 2.79. Hence, because most of the water pipe consumer society is young, especially women, policies and decisions need to be taken to control the supply of this tobacco to the market and more provide education on the health problem of water pipe smoking.

IMPLICATIONS

This study provides a higher effect of water pipe smoking on stroke. Physicians and researchers who intend to study in the field of stroke should better examine the effects of water pipe (including time of use, dose-response, long-term effects, and risk factors) on stroke.

Plasma Protein Binding and Tissue Retention Kinetics Influence the Rate and Extent of Nicotine Delivery to the Brain

Nicotine from inhaled combustible cigarette smoke is delivered rapidly to the brain, and sufficient unbound nicotine concentrations exert pharmacological effects. In addition to nicotine, combustible cigarette smoke also contains a significant number of toxicants that trigger perturbations, leading to an altered steady state due to differential expression of proteins. In this study, a physiologically based pharmacokinetic (PBPK) model for inhaled nicotine was used to simulate the influence of lysosomal change-driven tissue retention and plasma protein binding levels on nicotine pharmacokinetics (PK). A 3× increase in tissue lysosomal volumes lowered the nicotine brain maximum concentration (C_max) by 20.8%. Similarly, a 50% increase in plasma protein binding also lowered the unbound plasma arterial nicotine C_max by 39.4%. Such fundamental changes in nicotine disposition due to physiological changes in combustible cigarette smokers will lead to altered nicotine consumption and exposure-responses of other weakly basic drugs. Literature reports indicate that nicotine consumed from non-combustible products do not alter drug exposures, indicating fewer or less severe toxicant-driven perturbations with the use of these products. Although several other parameters influence nicotine PK, this PBPK modeling study shows that increased tissue retention and plasma protein binding reduce nicotine delivery to the brain and could lead to differential consumption of combustible cigarettes. These differences in physiological states among combustible cigarette smokers need to be evaluated and should be considered during therapeutic interventions. DATA AVAILABILITY: The model code is provided in supplementary information.

Biomarkers of Exposure and Potential Harm in Exclusive Users of Nicotine Pouches and Current, Former, and Never Smokers: Protocol for a Cross-sectional Clinical Study

Background

Tobacco harm reduction (THR) aims to reduce the health burden of cigarettes by encouraging smokers to switch to using alternative tobacco or nicotine products. Nicotine pouches (NPs) are smokeless, tobacco-free, oral products that may be beneficial as part of a THR strategy.

Objective

This 2-center, cross-sectional confinement study conducted in Denmark and Sweden aimed to determine whether biomarkers of exposure (BoEs) to tobacco toxicants and biomarkers of potential harm (BoPHs) in exclusive users of NPs show favorable differences compared with current smokers.

Methods

Participants were healthy NP users (target n=100) and current, former, or never smokers (target n=40 each), as confirmed by urinary cotinine and exhaled carbon monoxide concentrations. During a 24-hour confinement period, participants were asked to use their usual product (NP or cigarette) as normal, and BoEs and BoPHs were measured in blood and 24-hour urine samples, with compliance determined using anabasine, anatabine, and N-(2-cyanoethyl)valine. BoEs and BoPHs were compared between NP users and current, former, and never smokers. Urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (BoE to nicotine-derived nitrosamine ketone) and urinary 8-epi-prostaglandin F2α type III, exhaled nitric oxide, blood carboxyhemoglobin, white blood cell count, soluble intercellular adhesion molecule-1, and high-density lipoprotein cholesterol (BoPHs) were evaluated as primary outcomes. Other measures included urinary 11-dehydrothromboxane B2, forced expiratory volume, carotid intima-media thickness, self-reported quality of life, and oral health.

Results

The results of this study were received in mid-2022 and will be published in late 2022 to early 2023.

Conclusions

The results of this study will provide information on toxicant exposure and biomarkers associated with the development of smoking-related diseases among users of NPs compared with smokers, as well as on the potential role of NPs in THR.

Trial Registration

International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN16988167; https://www.isrctn.com/ISRCTN16988167

International Registered Report Identifier (IRRID)

DERR1-10.2196/39785

Comparing the Timeliness of Treatment in Younger vs. Older Patients with ST-Segment Elevation Myocardial Infarction: A Multi-Center Cohort Study

BACKGROUND

ST-segment elevation myocardial infarction (STEMI) predominantly affects older adults. Lower incidence among younger patients may challenge diagnosis.

OBJECTIVES

We hypothesize that among patients ≤ 50 years old, emergent percutaneous coronary intervention (PCI) for STEMI is delayed when compared with patients aged > 50 years.

METHODS

This 3-year, 10-center retrospective cohort study included emergency department (ED) STEMI patients ≥ 18 years of age treated with emergent PCI. We excluded patients with an electrocardiogram (ECG) completed prior to ED arrival or a nondiagnostic initial ECG. Our primary outcome was door-to-balloon (D2B) time. We compared characteristics and outcomes among younger vs. older STEMI patients, and among age subgroups.

RESULTS

There were 576 ED STEMI PCI patients, of whom 100 were ≤ 50 years old and 476 were > 50 years old. Median age was 44 years in the younger cohort (interquartile range [IQR] 41-47) vs. 62 years (IQR 57-70) among older patients. Median D2B time for the younger cohort was 76.5 min (IQR 67.5-102.5) vs. 81.0 min (IQR 65.0-105.5) in the older cohort (p = 0.91). This outcome did not change when ages 40 or 45 years were used to demarcate younger vs. older. The younger cohort had a higher prevalence of nonwhite races (38% vs. 21%; p < 0.001) and those currently smoking (36% vs. 23%; p = 0.005). The very young (≤30 years; 6/576) and very old (>80 years; 45/576) had 5.51 and 2.2 greater odds of delays.

CONCLUSION

We found no statistically significant difference in D2B times between patients ≤ 50 years old and those > 50 years old. Nonwhite patients and those who smoke were disproportionately represented within the younger population. The very young and very old had higher odds of D2B times > 90 min.

Partial Mediation by Cadmium Exposure of the Association Between Tobacco Smoking and Atherosclerotic Plaques in the Carotid Artery

Exposure to cadmium confers increased cardiovascular risk. Tobacco smoke contains cadmium, which, hypothetically, may mediate parts of the tobacco-associated risk of developing atherosclerotic plaques. Baseline data from the Swedish Malmö Diet and Cancer cohort (1991-1996) were used to test this hypothesis. Mediation analysis was used to examine associations between smoking and blood cadmium levels and the prevalence of ultrasound-assessed carotid atherosclerotic plaques. The total association with smoking status (never smokers, 2 categories of former smokers, and current smokers) was split into direct and indirect association, and the proportion mediated was estimated. The adjusted estimated plaque prevalence was approximately 27% among never smokers. We identified both a direct and an indirect pathway between smoking and carotid plaques; the indirect association, through cadmium, was observed among current smokers and former smokers who had quit smoking less than 15 years before. For current smokers, the prevalence ratio for plaque was 1.5, with 60%-65% of the association with smoking being mediated through cadmium. Recent former smokers had a prevalence ratio of 1.3, and 40%-45% was mediated through cadmium. Long-time former smokers had a prevalence ratio of 1.2, but none of the association was mediated through cadmium. In conclusion, about two-thirds of the proatherosclerotic association with smoking was mediated by cadmium.

Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products

Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.

A cross-sectional analysis of the association between marijuana and cigarette smoking with metabolic syndrome among adults in the United States

AIM

To assess the relationship between marijuana use, cigarette smoking and metabolic syndrome among adults in the United States who reported they use marijuana or cigarettes in comparison to non-marijuana and non-cigarette users.

METHOD

We conducted multiple logistic regression analyses using data from the 2011-2012 United States National Health and Nutrition Examination Survey to estimate relationships between cardio-metabolic risk factors and increasing years of smoking cigarette or marijuana use. Statistical adjustments were made for both demographic and endogenous factors related to recreational substance use.

RESULTS

Each year increase in marijuana use was significantly associated with increased odds of metabolic syndrome (OR=1.05; 95% CI: 1.01, 1.09), and hypertension (OR=1.04; 95% CI: 1.01, 1.07) adjusting for both demographic and endogenous factors related to recreational substance use. Each year increase in cigarette smoking was significantly associated with increased odds of hypertension (OR=1.03; 95% CI: 1.00, 1.06) and hyperglycemia (OR=1.03; 95% CI: 1.01, 1.05) after adjusting for confounders.

CONCLUSION

The results of this investigation suggest that increased years of marijuana or cigarette use are important factors in metabolic health; and consequently calls for the need to consider the potential negative effects of marijuana or cigarette for metabolic syndrome and its associated cardio-metabolic risk components.

A consideration of biomarkers to be used for evaluation of inflammation in human nutritional studies

To monitor inflammation in a meaningful way, the markers used must be valid: they must reflect the inflammatory process under study and they must be predictive of future health status. In 2009, the Nutrition and Immunity Task Force of the International Life Sciences Institute, European Branch, organized an expert group to attempt to identify robust and predictive markers, or patterns or clusters of markers, which can be used to assess inflammation in human nutrition studies in the general population. Inflammation is a normal process and there are a number of cells and mediators involved. These markers are involved in, or are produced as a result of, the inflammatory process irrespective of its trigger and its location and are common to all inflammatory situations. Currently, there is no consensus as to which markers of inflammation best represent low-grade inflammation or differentiate between acute and chronic inflammation or between the various phases of inflammatory responses. There are a number of modifying factors that affect the concentration of an inflammatory marker at a given time, including age, diet and body fatness, among others. Measuring the concentration of inflammatory markers in the bloodstream under basal conditions is probably less informative compared with data related to the concentration change in response to a challenge. A number of inflammatory challenges have been described. However, many of these challenges are poorly standardised. Patterns and clusters may be important as robust biomarkers of inflammation. Therefore, it is likely that a combination of multiple inflammatory markers and integrated readouts based upon kinetic analysis following defined challenges will be the most informative biomarker of inflammation.

Effects of tobacco smoking and nicotine on cancer treatment

A substantial number of the world's population continues to smoke tobacco, even in the setting of a cancer diagnosis. Studies have shown that patients with cancer who have a history of smoking have a worse prognosis than nonsmokers. Modulation of several physiologic processes involved in drug disposition has been associated with long-term exposure to tobacco smoke. The most common of these processes can be categorized into the effects of smoking on cytochrome P450-mediated metabolism, glucuronidation, and protein binding. Perturbation in the pharmacokinetics of anticancer drugs could result in clinically significant consequences, as these drugs are among the most toxic, but potentially beneficial, pharmaceuticals prescribed. Unfortunately, the effect of tobacco smoking on drug disposition has been explored for only a few marketed anticancer drugs; thus, little prescribing information is available to guide clinicians on the vast majority of these agents. The carcinogenic properties of several compounds found in tobacco smoke have been well studied; however, relatively little attention has been given to the effects of nicotine itself on cancer growth. Data that identify nicotine's effect on cancer cell apoptosis, tumor angiogenesis, invasion, and metastasis are emerging. The implications of these data are still unclear but may lead to important questions regarding approaches to smoking cessation in patients with cancer.

Influence of hypertension, obesity and nicotine abuse on quantitative and qualitative changes in acute-phase proteins in patients with essential hypertension

Background

Hypertension is a powerful risk factor for cardiovascular disease and frequently occurs in conjunction with obesity. Accumulative evidence suggests a link between inflammation and hypertension. The aim of study was to evaluate whether blood pressure, obesity and smoking may influence acute-phase response.

Material/Methods

Ninety-two patients with essential hypertension and 75 healthy volunteers as a control group were studied. In all subjects assessment of hsCRP, α1-acid glycoprotein (AGP), α1-antichymotrypsin, transferrin, α1-antitrypsin, and C3 and C4 complement were performed. Evaluation of glycosylation profile and reactivity coefficient (RC) for AGP was done by means of affinity immunoelectrophoresis with concanavalin A as a ligand.

Results

When compared to the controls, hypertensive subjects presented significantly higher hsCRP concentrations and lower transferrin level. Hypertensive patients had elevated AGP-AC. The intensification of the inflammatory reaction was greater in the subgroup of hypertensive patients smoking cigarettes. In obese hypertensives, elevated serum C3 complement level was found.

Conclusions

We conclude that arterial hypertension may evoke the acute-phase response in humans. Markers of acute-phase response are particularly strongly expressed in smokers. Serum C 3 complement, but not other APPs, is elevated in hypertension coexisting with obesity.

Lung function as a risk factor for subarachnoid hemorrhage: a prospective cohort study

BACKGROUND AND PURPOSE

The etiology of subarachnoid hemorrhage (SAH) is poorly understood. Reduced lung function, expressed as low forced expiratory volume in 1 second (FEV(1)) and low forced vital capacity (FVC), is a predictor of cardiovascular disease, but whether reduced lung function is a risk factor for SAH is not known. The association between lung function and incidence of SAH was investigated in a prospective cohort study.

METHODS

Between 1974 and 1992, 20 534 men and 7237 women (mean age, 44 years) were examined in a health screening program including spirometry. The incidence of SAH was studied during a mean follow-up of 26 years in relation to age- and height-standardized FEV(1), FVC, and FEV(1)/FVC.

RESULTS

One hundred forty-five subjects had a SAH (18.3 per 100 000 person-years in men and 26.5 per 100 000 person-years in women). The hazard ratio for SAH in the lowest compared to the highest quartile of FEV(1) and FEV(1)/FVC was 2.24 (95% CI, 1.32-3.81; P for trend=0.014) and 1.92 (95% CI, 1.14-3.23; P for trend=0.003), respectively, after adjustment for several confounding factors including smoking and hypertension. The results persisted when analysis was restricted to nonsmokers. FVC showed no significant association with incidence of SAH.

CONCLUSIONS

Baseline lung function, expressed as low FEV(1) or FEV(1)/FVC, is a risk factor for SAH, independently of smoking.

Clinical assessment, neuroimaging and immunomarkers in Chagas disease study (CLINICS): Rationale, study design and preliminary findings

Chagas disease (CD) is an important cause of cardiomyopathy and stroke in Brazil. Brain infarcts and atrophy seem to occur independently of cardiomyopathy severity and cognitive impairment is understudied.

OBJECTIVE

Compare the prevalence of brain magnetic resonance imaging abnormalities between patients with or without CD; determine if inflammatory biomarkers are increased in CD; and determine the efficacy of aspirin in reducing the rate of microembolization in these patients.

METHODS

500 consecutive patients with heart failure will undergo a structured cognitive evaluation, biomarker collection and search for microembolic signals on transcranial Doppler. The first 90 patients are described, evaluated with cognitive tests and brain magnetic resonance imaging to measure N-acetyl aspartate (NAA), choline (Cho), myo-inositol (MI) and creatine (Cr).

RESULTS

Mean age was 55±11 years, 51% female, 38 (42%) with CD. Mean NAA/Cr ratio was lower in patients with CD as compared to other cardiomyopathies. Long-term memory and clock-drawing test were also significantly worse in CD patients. In the multivariable analysis correcting for ejection fraction, age, sex and educational level, reduced NAA/Cr (p=0.006) and cognitive dysfunction (long-term memory, p=0.023; clock-drawing test, p=0.015) remained associated with CD.

CONCLUSION

In this preliminary sample, CD was associated with cognitive impairment and decreased NAA/Cr independently of cardiac function or educational level.

[Tumor necrosis factor as an early marker of inflammation in healthy smokers]

BACKGROUND AND OBJECTIVES

Smoking creates an inflammation that leads to lose of lung function. Tumor necrosis factor alpha (TNF-α) is a cytokine that plays an important role in the pathogenesis of chronic obstructive pulmonary disease. There is a need to develop methods for an early detection of an impaired lung function in smokers. We aimed to show that smokers have higher levels of TNF-α in serum and exhaled breath condensate (EBC). We also analysed the influence of sex, age and weight on TNF-α, and determined the association between smoking, pulmonary function and TNF-α.

PATIENTS AND METHODS

Prospective study of smokers and non-smokers without any known disease. Respiratory function tests, EBC and blood samples were performed before smoking cessation.

STATISTICAL ANALYSIS

SPSS 11.0.

RESULTS

Fifty-one patients (60.8% smokers), 56.9% females, mean age 39.88 years old. Smokers initiated at an age of 15.77 years; the mean of cigarettes/day was 21.68. Significant differences in TNF-α serum levels between smokers and non-smokers were observed (P<.043). Differences did not reach significance for EBC. For tobacco consumption data, only age at smoking initiation and serum TNF-α levels had a correlation. A significant relation between TNF-α serum levels and forced expiratory volume in one second and forced vital capacity was found.

CONCLUSIONS

Smokers show higher TNF-α levels in serum. Number of years of smoking has an influence on TNF-α levels. There is a modest correlation between pulmonary function and plasma TNF-α levels, but not for EBC.

Clinical and inflammatory factors associated with body mass index in elderly patients with chronic obstructive pulmonary disease

AIM

Body mass index (BMI) is closely associated with mortality in chronic obstructive pulmonary disease (COPD). Systemic inflammation has been suggested as one of the mechanisms of malnutrition in COPD. This study investigated the relationships of clinical variables and inflammatory biomarkers with BMI in COPD in an aging population.

METHODS

Baseline levels of serum biomarkers were determined for 69 patients with stable male COPD. Multivariate logistic regression was used to evaluate associations between clinical variables, including emphysema scores, and biomarkers with BMI.

RESULTS

Twenty eight patients were categorized as low BMI (<20 kg/m2). BMI was inversely correlated with serum α1-antitrypsin (α1-AT) concentration and emphysema scores, and was positively correlated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Multivariate logistic regression analysis showed that α1-AT was independently associated with BMI.

CONCLUSION

Low BMI was associated with the severity of emphysema and systemic inflammation reflected by elevated α1-AT level.

Systemic molecular and cellular changes induced in rats upon inhalation of JP-8 petroleum fuel vapor

Limited information is available regarding systemic changes in mammals associated with exposures to petroleum/hydrocarbon fuels. In this study, systemic toxicity of JP-8 jet fuel was observed in a rat inhalation model at different JP-8 fuel vapor concentrations (250, 500, or 1000 mg/m(3), for 91 days). Gel electrophoresis and mass spectrometry sequencing identified the alpha-2 microglobulin protein to be elevated in rat kidney in a JP-8 dose-dependent manner. Western blot analysis of kidney and lung tissue extracts revealed JP-8 dependent elevation of inducible heat shock protein 70 (HSP70). Tissue changes were observed histologically (hematoxylin and eosin staining) in liver, kidney, lung, bone marrow, and heart, and more prevalently at medium or high JP-8 vapor phase exposures (500-1000 mg/m(3)) than at low vapor phase exposure (250 mg/m(3)) or non-JP-8 controls. JP-8 fuel-induced liver alterations included dilated sinusoids, cytoplasmic clumping, and fat cell deposition. Changes to the kidneys included reduced numbers of nuclei, and cytoplasmic dumping in the lumen of proximal convoluted tubules. JP-8 dependent lung alterations were edema and dilated alveolar capillaries, which allowed clumping of red blood cells (RBCs). Changes in the bone marrow in response to JP-8 included reduction of fat cells and fat globules, and cellular proliferation (RBCs, white blood cells-WBCs, and megakaryocytes). Heart tissue from JP-8 exposed animals contained increased numbers of inflammatory and fibroblast cells, as well as myofibril scarring. cDNA array analysis of heart tissue revealed a JP-8 dependent increase in atrial natriuretic peptide precursor mRNA and a decrease in voltage-gated potassium (K+) ion channel mRNA.

Smoking and atherosclerotic cardiovascular disease: part II: role of cigarette smoking in cardiovascular disease development

Potential mechanisms and biomarkers of atherosclerosis related to cigarette smoking - a modifiable risk factor for that disease - are discussed in this article. These include smoking-associated inflammatory markers, such as leukocytes, high-sensitivity C-reactive protein, serum amyloid A, ICAM-1 and IL-6. Other reviewed markers are indicative for smoking-related impairment of arterial endothelial function (transcapillary leakage of albumin, inhibition of endogenous nitric oxide synthase activity and reduced endothelium-dependent vasodilation) or point to oxidative stress caused by various chemicals (cholesterol oxidation, autoantibodies to oxidized low-density lipoprotein, plasma levels of malondialdehyde and F(2)-isoprostanes and reduced antioxidant capacity). Smoking enhances platelet aggregability, increases blood viscosity and shifts the pro- and antithrombotic balance towards increased coagulability (e.g., fibrinogen, von Willebrand factor, ICAM-1 and P-selectin). Insulin resistance is higher in smokers compared with nonsmokers, and hemoglobin A1c is dose-dependently elevated, as is homocysteine. Smoke exposure may influence the kinetics of markers with different response to transient or chronic changes in cigarette smoking behavior.

Leukocyte count is associated with incidence of coronary events, but not with stroke: a prospective cohort study

OBJECTIVE

Elevated leukocyte count is a classic marker of systemic inflammation. This study examined whether the leukocyte count is associated with incidence of coronary events (CE) and stroke during a long follow-up period.

METHODS

A total of 17,131 men and 2932 women, aged 27-61 years, without history of cardiovascular disease (CVD), were enrolled. Incidence of CE and stroke was studied in relation to leukocyte concentrations over a mean follow-up of 24 years.

RESULTS

During the follow-up period, 2600 CE and 1333 stroke events occurred. After risk factor adjustments, leukocyte concentrations in the highest quartile (vs. lowest, >7.0 vs. <4.7 x 10(9)cells/L) were associated with CE in men (HR: 1.31, 95%CI: 1.16-1.48, trend p<0.001), but not significantly in women (HR: 1.46, CI: 0.87-2.46, trend p=0.13). The increased incidence remained significant after adjustments for plasma fibrinogen in a sub-group of 6018 men (HR: 1.31, CI: 1.08-1.60). The association between leukocytes and CE was most pronounced in younger men (aged 27-46) and men without hypertension. In younger men, high leukocytes were associated with early CE (within 10 years of follow-up) and late CE (>10 years of follow-up). In older men (46-61 years), leukocytes were not associated with CE after more than 10 years of follow-up. The leukocyte count was not associated with incidence of stroke.

CONCLUSION

Elevated leukocyte count in men is associated with increased incidence of CE, but not with stroke. The increased risk persisted after more than 10 years of follow-up in younger, but not in older men.

Haptoglobin and risk of myocardial infarction, stroke, and congestive heart failure in 342,125 men and women in the Apolipoprotein MOrtality RISk study (AMORIS)

BACKGROUND

Few studies have analysed the importance of haptoglobin (Hp) as a risk factor for acute myocardial infarction (AMI), stroke, and heart failure (HF) in large healthy populations.

AIMS

We examined Hp as risk factor for AMI, stroke, and HF in the Apolipoprotein MOrtality RISk (AMORIS) Study and compared its predictive strength with that of total serum cholesterol (TC).

METHODS

Prospective study (11.8 years) of AMI, stroke, and HF through linkage with Swedish hospital discharge and mortality registers with measurements of Hp in 342,125 subjects.

RESULTS

Hp is a significant risk factor of AMI, stroke, and HF. Relationships were stronger for men than women with regard to stroke and HF, but not AMI. Hp was almost as predictive as TC for AMI and about equally predictive of stroke with a stronger relationship to ischaemic than haemorrhagic stroke. A 4.2-fold increase in risk of AMI was observed comparing subjects in the joint lower quartiles of TC and Hp to those in the upper. For stroke, the risk increase was 2-fold, and 1.5-fold for HF.

INTERPRETATION

The inflammation marker Hp carried as much additional predictive information value on AMI and stroke as TC. Hp was also a risk factor of HF.

Release of cardiac biochemical and inflammatory markers in patients on cardiopulmonary bypass undergoing coronary artery bypass grafting

BACKGROUND

Determination of cardiac markers can assess cardiac injury induced by cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG). However, the markers and their release pattern are not well defined. This study was aimed at assessing the release and timing of cardiac biochemical and inflammatory markers in patients undergoing elective CABG with CPB.

METHODS

Forty patients undergoing elective CABG were included in this study. Blood samples were collected for biochemical measurements at the following time points: immediately prior to the induction of anesthesia, one, six, 12, and 24 hours after initiation of CPB.

RESULTS

Increased release of cardiac troponin I was observed one hour after initiation of CPB (p < 0.05) and reached the maximum at 12 hours after CPB (p < 0.01). Serum CK-MB enzyme activity and CK-MB mass both were highly elevated starting at one hour after initiation of CPB, peaked at six hours, and remained elevated until 24 hours after CPB. Both lactate and lactate dehydrogenase were highly elevated six hours after CPB and peaked at 12 hours after CPB (p < 0.01). Serum levels of interleukin-6 and tumor necrosis factor-alpha increased significantly one hour after initiation of CPB and peaked at six hours (p < 0.01), while serum high sensitivity C-reactive protein levels started to elevate 12 hours after CPB (p < 0.01).

CONCLUSION

Monitoring of these markers could help to determine implementation of protective interventions during CABG with CPB to prevent myocardial deterioration and to predict the risk and prognosis.

Comorbidities in chronic obstructive pulmonary disease

Comorbidities such as cardiac disease, diabetes mellitus, hypertension, osteoporosis, and psychological disorders are commonly reported in patients with chronic obstructive pulmonary disease (COPD) but with great variability in reported prevalence. Tobacco smoking is a risk factor for many of these comorbidities as well as for COPD, making it difficult to draw conclusions about the relationship between COPD and these comorbidities. However, recent large epidemiologic studies have confirmed the independent detrimental effects of these comorbidities on patients with COPD. On the other hand, many of these comorbidities are now considered to be part of the commonly prevalent nonpulmonary sequelae of COPD that are relevant not only to the understanding of the real burden of COPD but also to the development of effective management strategies.

Inflammation-sensitive plasma proteins are associated with increased incidence of heart failure: a population-based cohort study

BACKGROUND

Although inflammation has been associated with different cardiovascular diseases, the relationships with future heart failure (HF) are unclear. This population-based study explored whether elevated plasma levels of inflammatory proteins are associated with incidence of HF.

METHODS

Five inflammation-sensitive plasma proteins (ISPs, fibrinogen, ceruloplasmin, haptoglobin, orosomucoid, and alpha1-antitrypsin) was measured in 6071 men (mean age 46 years) without history of myocardial infarction (MI) or stroke. Incidence of hospitalizations due to HF (primary diagnosis) was monitored over 22 years of follow-up, in relation to the number of elevated ISPs (i.e., in the 4th quartile). Subjects with myocardial infarction during follow-up were censored.

RESULTS

During the follow-up, 159 men were hospitalized due to HF. Baseline levels of all ISPs, except for haptoglobin, were significantly higher in men who developed HF. After adjustments for confounding factors, the hazard ratios (HR) of HF were 1.00 (reference), 1.7 (95% CI: 1.1-2.7), 2.0 (CI: 1.2-3.3) and 2.6 (CI: 1.6-4.1), respectively, in men with none, one, two and three or more ISPs in the 4th quartile (trend: p<0.001). Of the individual ISPs, fibrinogen, ceruloplasmin and alpha1-antitrypsin showed significant relationships with incidence of HF after adjustment for risk factors.

CONCLUSION

Plasma levels of inflammatory markers are associated with long-term incidence of hospitalizations due to HF in middle-aged men.

Systemic inflammation in chronic obstructive pulmonary disease and asthma: Similarities and differences

BACKGROUND AND OBJECTIVE

While recent studies have shown that patients with COPD and patients with asthma exhibit evidence of airway and systemic inflammation, markers of systemic inflammation have not been compared between the two diseases.

METHODS

To evaluate circulating inflammatory markers, blood was sampled from 111 patients with COPD, 75 control subjects and 46 asthmatic patients (some of whom were smokers). Measurements of WCC, serum levels of fibrinogen, high-sensitivity (hs)-CRP, IL-8, IL-6, tumour necrosis factor-alpha (TNF-alpha), transforming growth factor (TGF)-beta1, tissue inhibitors of metalloproteinase (TIMP)-1, neutrophil elastase and alpha1-antitrypsin (alpha1-AT) were performed.

RESULTS

Serum TNF-alpha, IL-6 and TIMP-1 concentrations were significantly higher in patients with stable COPD and patients with asthma than in control patients. Serum alpha1-AT levels were significantly higher in COPD patients than in asthmatic patients and control subjects, and serum TGF-beta1 levels were higher in asthma patients than in COPD patients. Smoking status had no effect on markers in COPD and asthmatic patients.

CONCLUSIONS

Although COPD and asthma share common markers of systemic inflammation, serum levels of TGF-beta1 and alpha1-AT may reflect differences between the diseases.

Systemic effects of smoking

Smoking is one of the major lifestyle factors influencing the health of human beings. Life-long cigarette smokers have a higher prevalence of common diseases such as atherosclerosis and COPD with significant systemic impact. The present review evaluates current knowledge concerning possible pathways through which cigarette smoking can affect human health, with special focus on extrapulmonary effects. Long-term smoke exposure can result in systemic oxidants-antioxidants imbalance as reflected by increased products of lipid peroxidation and depleted levels of antioxidants like vitamins A and C in plasma of smokers. A low-grade systemic inflammatory response is evident in smokers as confirmed by numerous population-based studies: elevated levels of C-reactive protein (CRP), fibrinogen, and interleukin-6, as well as increased counts of WBC have been reported. Furthermore, rheologic, coagulation and endothelial function markers like hematocrit, blood and/or plasma viscosity, fibrin d-dimer, circulating adhesion molecules (intracellular adhesion molecule-1, selectins), tissue plasminogen activator antigen, and plasminogen activator inhibitor type I are altered in chronic cigarette smokers. Although most of smoking-induced changes are reversible after quitting, some inflammatory mediators like CRP are still significantly raised in ex-smokers up to 10 to 20 years after quitting, suggesting ongoing low-grade inflammatory response persisting in former smokers. New longitudinal epidemiologic and genetic studies are required to evaluate the role of smoking itself and possible gene/environment interplay in initiation and development of smoking-induced common diseases affecting humans.

Smoking interacts with sleep apnea to increase cardiovascular risk

BACKGROUND

Sleep apnea syndrome is an important risk factor for atherosclerosis and cardiovascular morbidity and so is cigarette smoking. In both atherosclerosis and cardiovascular disease, oxidative stress and inflammation have been implicated as underlying pathophysiologic mechanisms. We investigated oxidative stress and inflammatory markers in 70 non-smoking and smoking patients with sleep apnea.

METHODS

Thirty-five sleep apnea patients aged 20-60 years who smoke 20 or more cigarettes/day and for at least 5 years were individually matched by gender, age (+/-5 years), body mass index (BMI; categorized as, 'normal weight', 'overweight', and 'obese'), sleep apnea severity (categorized as 'mild', 'moderate', and 'severe'), and presence of cardiovascular diseases, with 35 patients who never smoked. Blood samples were drawn after an overnight fasting for determination of lipids profile, oxidative stress markers thiobarbituric acid reactive substances, peroxides and paraoxonase-1 and inflammatory markers C-reactive protein, ceruloplasmin, and haptoglobin.

RESULTS

Smokers showed significantly higher levels of C-reactive protein, ceruloplasmin, and haptoglobin and triglycerides and lower levels of high-density lipoprotein (HDL) cholesterol than non-smokers. There was a significant interaction effect between smoking and apnea severity on ceruloplasmin and HDL levels. Smokers with severe sleep apnea had the highest level of ceruloplasmin and the lowest level of HDL.

CONCLUSION

There is a synergistic effect between cigarette smoking and sleep apnea on some of the biochemical cardiovascular risk markers. Patients with severe sleep apnea who smoke are at a greater cardiovascular risk than smokers with mild-moderate sleep apnea and patients who do not smoke.

Occupation, Marital Status, and Low-Grade Inflammation

Objective— We explored the relationships between inflammatory proteins, occupation, and marital status, and their independent associations with incidence of cardiovascular disease (CVD).

Methods and Results— Five inflammation-sensitive proteins (ISPs) (fibrinogen, ceruloplasmin, haptoglobin, α1-antitrypsin, orosomucoid) were measured in 6075 apparently healthy men. Incidence of coronary events and stroke was followed over 18 years in relation to occupation and marital status. All ISPs showed higher concentrations in divorced men and in manual workers. Except for fibrinogen, this remained significant after adjustments for confounding factors. Adjusted for traditional cardiovascular risk factors, incidence of coronary events was significantly increased in unskilled manual workers and in divorced men. The relative risks were slightly reduced after further adjustments for ISPs (from 1.79 to 1.70 in unskilled manual workers; from 1.58 to 1.51 in divorced men). All ISPs were significantly associated with incidence of coronary events, after adjustments for traditional risk factors. This relationship was essentially unchanged after further adjustments for occupation and marital status.

Conclusion— Inflammation could contribute to, but not fully explain, the increased cardiovascular risk in manual workers and divorced men. Although the ISPs vary greatly by occupational and marital status, this does not confound the relationship between ISPs and incidence of CVD.

C-reactive protein and cardiovascular outcomes in smokers versus nonsmokers in non-ST-elevation acute coronary syndrome (from the TACTICS-TIMI 18 trial)

We investigated the role of inflammation, as measured by high-sensitivity C-reactive protein (CRP) levels, in cardiovascular risk in smokers who have acute coronary syndrome. Despite fewer traditional risk factors, smokers who had acute coronary syndrome had higher CRP levels than did nonsmokers (7.0 vs 5.1 mg/L, p <0.001). CRP was associated with adverse cardiovascular outcomes in smokers and nonsmokers, even when adjusted for the presence of pulmonary disease.

Heterogeneity of cardiovascular risk among smokers is related to degree of carbon monoxide exposure

BACKGROUND

Between smokers matched for daily tobacco consumption there are marked variations of the cardiovascular risk. This follow up of the population based cohort "Men born in 1914" from Malmö, Sweden, explored whether this is accounted for by the levels of carbon monoxide (CO).

METHODS

Three hundred and sixty-five men without history of cardiovascular disease (CVD) were followed over 27 years. Leg artery disease was defined as a systolic ankle-arm pressure ratio (ABPI) below 0.9 in either leg. Incidence of myocardial infarction (MI), stroke and deaths is based on linkage with regional and national registers. The distribution of CO in blood and expired air, respectively, was divided into quartiles.

RESULTS

There was a significant inverse relation between ABPI and CO in blood and expired air. Incidence of CVD events and deaths increased progressively with degree of CO exposure. Men with CO in the top quartile had significantly increased risks of CVD events (RR: 2.2; 95% CI: 1.00-4.6) and cardiovascular deaths (RR: 3.2, CI: 1.2-8.3), adjusted for daily tobacco consumption and other potential confounders.

CONCLUSIONS

In smokers, the prevalence of leg atherosclerosis and incidence of cardiovascular disease is related to the amount of carbon monoxide in blood or expired air.