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Heikkinen J, Palosaari S, Lehenkari P. Cigarette smoke extract decreases human bone marrow mesenchymal stromal cell adipogenic differentiation. Toxicol In Vitro 2024; 101:105949. [PMID: 39343071 DOI: 10.1016/j.tiv.2024.105949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 09/10/2024] [Accepted: 09/26/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Smoking and nicotine impose detrimental health effects including adipose tissue dysfunction. Despite extensive physiological evidence, the cellular mechanisms remain poorly understood, with few studies examining the effects of cigarette smoke extract (CSE) or nicotine on adipocyte differentiation. METHODS Primary human bone marrow-derived mesenchymal stromal cells (MSCs) were exposed to CSE or nicotine (50-500 ng/ml) during adipogenic differentiation. Cell viability and metabolic activity were assessed via MTT assay. Lipid droplet accumulation was evaluated using Sudan III staining and quantitative image analysis. Adiponectin, IL6, and IL8 concentrations were measured after 35 days using ELISA. RESULTS At these doses, CSE and nicotine do not immediately affect cell viability but inhibit undifferentiated cell proliferation. Notably, both agents at 50 ng/ml significantly increased lipid accumulation during adipogenesis, while higher CSE doses nearly completely inhibited this process. Additionally, CSE dose-dependently decreased adiponectin secretion and increased IL6 and IL8, indicating a shift towards an inflammatory state. Nicotine alone primarily increased IL6 secretion with less pronounced effects. CONCLUSION The study highlights the complex impact of CSE and nicotine on adipocyte function during early differentiation from MSCs. Dose-dependent changes in lipid accumulation, cytokine, and adiponectin secretion induced by CSE and nicotine can partly explain smoking-related adipose tissue dysfunction.
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Affiliation(s)
- Janne Heikkinen
- Medical Faculty, Translational Medicine Research Unit, University of Oulu, Oulu, Finland.
| | - Sanna Palosaari
- Medical Faculty, Translational Medicine Research Unit, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Petri Lehenkari
- Medical Faculty, Translational Medicine Research Unit, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland; Division of Orthopaedic Surgery, Oulu University Hospital, Oulu, Finland.
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2
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Thanglen H, Zimik U, Thanglen R, Pemmichon RM, Chanak M, Bose K. Anthropometric markers and their cut-off point for the prediction of hypertension with lifestyle as a risk factor among Chiru tribe of North East India. ETHNICITY & HEALTH 2024; 29:505-522. [PMID: 38627237 DOI: 10.1080/13557858.2024.2342326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/06/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The increased prevalence of obesity, particularly central obesity, is closely associated with many metabolic complexions, including hypertension and diabetes. OBJECTIVES The present study investigates the cut-off points of some anthropometric measurements such as body mass index [BMI (kg/m2)], waist circumference [WC (cm)], waist-hip ratio (WHR), and waist-height ratio (WHtR) associated with high blood pressure. It determines the risk factors among the Chiru tribe of North East India. METHODS The cross-sectional study was conducted in four villages in the hilly districts of Manipur. For the present study, 416 Chiru adults (209 males and 207 females) aged 20-79 years were included. Anthropometrics and blood pressure were measured using standard procedures. Statistical methods such as chi-square, Pearson correlation, and multivariate logistic regression were employed. RESULTS The result indicates that the cut-off values to detect hypertension were 21.83 for BMI, 82.55 for WC, 0.92 for WHR, and 0.53 for WHtR. However, the cut-off values to detect hypertension in females were 23.92 for BMI, 86.48 for WC, 0.94 for WHR, and 0.55 for WHtR. Multivariate logistic regression analysis indicated that hypertension was an independently associated risk factor in both males and females with an age ≥ 50 years (OR = 18.52 and 10.12), physical activity (OR = 0.10 and 0.21), salt intake (OR = 7.81 and 3.36), and smoking (OR = 2.56 and 3.23), respectively. CONCLUSION It has been concluded that BMI, WC, WHR, and WHtR values can determine hypertension risk in the Chiru population. Age, smoking, physical activity, and salt intake were independent risk factors associated with high blood pressure.
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Affiliation(s)
- Hosea Thanglen
- Department of Anthropology, Rajiv Gandhi University, Arunachal Pradesh, India
| | - Urapam Zimik
- Department of Anthropology, Kamakhya Pemton College, Manipur, India
| | | | - R M Pemmichon
- Department of Anthropology, Manipur University, Manipur, India
| | - Mahua Chanak
- Department of Anthropology, Vidyasagar University, Midnapore, India
| | - Kaushik Bose
- Department of Anthropology, Vidyasagar University, Midnapore, India
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Pataka A, Kotoulas SC, Karkala A, Tzinas A, Kalamaras G, Kasnaki N, Sourla E, Stefanidou E. Obstructive Sleep Apnea and Smoking Increase the Risk of Cardiovascular Disease: Smoking Cessation Pharmacotherapy. J Clin Med 2023; 12:7570. [PMID: 38137639 PMCID: PMC10743586 DOI: 10.3390/jcm12247570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with significant morbidity and mortality. There are few existing data examining how pharmacological treatment, such as nicotine replacement therapy (NRT), bupropion, and varenicline, affect smokers suffering with OSA and especially their cardiovascular effects. The aim of this review was to evaluate the effects of smoking cessation pharmacotherapy on OSA with a special emphasis on the cardiovascular system. Results: Only small studies have assessed the effect of NRTs on OSA. Nicotine gum administration showed an improvement in respiratory events but with no permanent results. No specific studies were found on the effect of bupropion on OSA, and a limited number evaluated varenicline's effects on sleep and specifically OSA. Varenicline administration in smokers suffering from OSA reduced the obstructive respiratory events, especially during REM. Studies on second-line medication (nortriptyline, clonidine, cytisine) are even more limited. There are still no studies evaluating the cardiovascular effects of smoking cessation medications on OSA patients. Conclusions: Sleep disturbances are common withdrawal effects during smoking cessation but could be also attributed to pharmacotherapy. Smokers should receive personalized treatment during their quitting attempts according to their individual needs and problems, including OSA. Future studies are needed in order to evaluate the efficacy and safety of smoking cessation medications in OSA patients.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | | | - Aliki Karkala
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Asterios Tzinas
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - George Kalamaras
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Nectaria Kasnaki
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Evdokia Sourla
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Emiliza Stefanidou
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
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Kim MM, Steffensen I, Miguel RTD, Babic T, Johnson AD, Carlone J, Potts R, Junker CS. Study title: A systematic review of RCTs to examine the risk of adverse cardiovascular events with nicotine use. Front Cardiovasc Med 2023; 10:1111673. [PMID: 37025687 PMCID: PMC10071010 DOI: 10.3389/fcvm.2023.1111673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/03/2023] [Indexed: 04/08/2023] Open
Abstract
Associations between cigarette smoking and increased risk of cardiovascular disease are well established. However, it is unclear whether the association is mediated by exposure to nicotine and/or to other constituents in cigarette smoke. The objective of this systematic review and meta-analysis of randomized control trials (RCTs) was to identify any potential associations between exposure to nicotine and the risk of clinically diagnosed adverse cardiovascular events in adult current users and nonusers of tobacco products. Among 1,996 results, 42 studies, comparing nicotine and non-nicotine groups, were included and were both qualitatively and quantitatively synthesized across the outcomes of arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death. The majority of studies evaluating nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death reported no events that occurred in either the nicotine or non-nicotine control groups. Among the studies that reported events, rates of adverse events were similarly low between both groups. Consistent with findings from previous systematic reviews and meta-analyses, pooled data showed that rates for arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death were not significantly different between nicotine and non-nicotine groups. The overall quality of the body of evidence for each of the four outcomes of interest was graded as "moderate," limited only by the imprecision of results. The findings of this systematic review and meta-analysis indicate that, with moderate certainty, there are no significant associations between the use of nicotine and the risk of clinically diagnosed adverse cardiovascular events-specifically, arrhythmia, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death.
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Affiliation(s)
- Mimi M. Kim
- RAI Services Company, Reynolds American Inc., Winston-Salem, NC, United States
- *Correspondence: Mimi M. Kim,
| | | | | | | | - Aubrey D. Johnson
- RAI Services Company, Reynolds American Inc., Winston-Salem, NC, United States
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Yang D, Chen J, Zhang T, Lin Y, Yao X, Meng L, Guo F, Chen K, Dai H, Tang M. Influencing factors of wide pulse pressure in an elderly Chinese population: A cross-sectional study. J Clin Hypertens (Greenwich) 2022; 24:1482-1490. [PMID: 36259250 DOI: 10.1111/jch.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
Blood pressure and pulse pressure (PP) had their own characteristics in the elderly population. This cross-sectional study including 5030 elderly participants was conducted to describe the distribution of blood pressure and wide PP in the elderly population and find influencing factors of wide PP. Wide PP was defined as PP equal to or more than 65 mmHg, and was classified three types as low systolic blood pressure (SBP) and low diastolic blood pressure (DBP) (LSLD), high SBP and low DBP (HSLD), and high SBP and high DBP (HSHD). Using multivariate logistic regression models to analyze the associations of demographic factors, health-related factors and lifestyle factors with different wide PP types. The associations of lifestyles with wide PP by gender were estimated by subgroup analyses. Among 5030 elderly participants, 2727 (54.2%) participants had wide PP. Logistic regression models showed older age (OR = 2.48, 95%CI: 2.14-2.88), female (OR = 1.31, 95%CI: 1.07-1.60), not married (OR = 1.26, 95%CI: 1.07-1.49), having chronic diseases (OR = 1.28, 95%CI: 1.09-1.50), current alcohol drinker (OR = 1.29, 95%CI: 1.11-1.50) were positively associated, and higher body height (OR = .78, 95%CI: .62-.99), higher education level (OR = .60, 95%CI: .43-.82), current smoker (OR = .79, 95%CI: .64-.97) were negatively associated with wide PP. Among three different types of wide PP including LSLD, HSLD, HSHD, these factors had different effects. Subgroup analyses found that only among male, current smoker was negatively associated and current alcohol drinker was positively associated with wide PP.
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Affiliation(s)
- Dandan Yang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Chen
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Tingting Zhang
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yaoyao Lin
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuecheng Yao
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Meng
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fanjia Guo
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honglei Dai
- Fourth Affiliated Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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6
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Altered Fetal Cardiac Function in Smoking During Pregnancy. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-022-00349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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7
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Klein LW. Systemic and Coronary Hemodynamic Effects of Tobacco Products on the Cardiovascular System and Potential Pathophysiologic Mechanisms. Cardiol Rev 2022; 30:188-196. [PMID: 34001689 DOI: 10.1097/crd.0000000000000395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Tobacco product usage is the single most preventable cause of death in the United States. Smoking promotes atherosclerosis, producing disease in the coronary arteries, the aorta, the carotid and cerebral arteries and the large arteries in the peripheral circulation. The cardiovascular consequences of tobacco products have been the subject of intensive study for several decades. Despite the overwhelming epidemiologic association between smoking and vascular disease, the pathophysiologic mechanisms by which smoking exerts its deleterious effects remain incompletely understood. This review addresses the acute and long-term systemic and coronary hemodynamic effects of tobacco, with an emphasis of the impact on coronary blood flow and pathophysiologic mechanisms.
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Affiliation(s)
- Lloyd W Klein
- From the Cardiology Division, University of California, San Francisco, San Francisco, CA
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Whitehead AK, Fried ND, Li Z, Neelamegam K, Pearson CS, LaPenna KB, Sharp TE, Lefer DJ, Lazartigues E, Gardner JD, Yue X. Alpha7 nicotinic acetylcholine receptor mediates chronic nicotine inhalation-induced cardiopulmonary dysfunction. Clin Sci (Lond) 2022; 136:973-987. [PMID: 35678315 PMCID: PMC10199464 DOI: 10.1042/cs20220083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 12/17/2022]
Abstract
Cigarette smoking remains the leading modifiable risk factor for cardiopulmonary diseases; however, the effects of nicotine alone on cardiopulmonary function remain largely unknown. Previously, we have shown that chronic nicotine vapor inhalation in mice leads to the development of pulmonary hypertension (PH) with right ventricular (RV) remodeling. The present study aims to further examine the cardiopulmonary effects of nicotine and the role of the α7 nicotinic acetylcholine receptor (α7-nAChR), which is widely expressed in the cardiovascular system. Wild-type (WT) and α7-nAChR knockout (α7-nAChR-/-) mice were exposed to room air (control) or nicotine vapor daily for 12 weeks. Consistent with our previous study, echocardiography and RV catheterization reveal that male WT mice developed increased RV systolic pressure with RV hypertrophy and dilatation following 12-week nicotine vapor exposure; in contrast, these changes were not observed in male α7-nAChR-/- mice. In addition, chronic nicotine inhalation failed to induce PH and RV remodeling in female mice regardless of genotype. The effects of nicotine on the vasculature were further examined in male mice. Our results show that chronic nicotine inhalation led to impaired acetylcholine-mediated vasodilatory response in both thoracic aortas and pulmonary arteries, and these effects were accompanied by altered endothelial nitric oxide synthase phosphorylation (enhanced inhibitory phosphorylation at threonine 495) and reduced plasma nitrite levels in WT but not α7-nAChR-/- mice. Finally, RNA sequencing revealed up-regulation of multiple inflammatory pathways in thoracic aortas from WT but not α7-nAChR-/- mice. We conclude that the α7-nAChR mediates chronic nicotine inhalation-induced PH, RV remodeling and vascular dysfunction.
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Affiliation(s)
- Anna K. Whitehead
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Nicholas D. Fried
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Zhen Li
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Kandasamy Neelamegam
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Charlotte S. Pearson
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Kyle B. LaPenna
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Thomas E. Sharp
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Department of Medicine Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - David J. Lefer
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Eric Lazartigues
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
- Southeast Louisiana Veterans Health Care Systems, New Orleans, LA 70119, U.S.A
| | - Jason D. Gardner
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
| | - Xinping Yue
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, U.S.A
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Development of an MRI-Compatible Nasal Drug Delivery Method for Probing Nicotine Addiction Dynamics. Pharmaceutics 2021; 13:pharmaceutics13122069. [PMID: 34959350 PMCID: PMC8708378 DOI: 10.3390/pharmaceutics13122069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
Substance abuse is a fundamentally dynamic disease, characterized by repeated oscillation between craving, drug self-administration, reward, and satiety. To model nicotine addiction as a control system, a magnetic resonance imaging (MRI)-compatible nicotine delivery system is needed to elicit cyclical cravings. Using a concentric nebulizer, inserted into one nostril, we delivered each dose equivalent to a single cigarette puff by a syringe pump. A control mechanism permits dual modes: one delivers puffs on a fixed interval programmed by researchers; with the other, subjects press a button to self-administer each nicotine dose. We tested the viability of this delivery method for studying the brain’s response to nicotine addiction in three steps. First, we established the pharmacokinetics of nicotine delivery, using a dosing scheme designed to gradually achieve saturation. Second, we lengthened the time between microdoses to elicit craving cycles, using both fixed-interval and subject-driven behavior. Finally, we demonstrate a potential application of our device by showing that a fixed-interval protocol can reliably identify neuromodulatory targets for pharmacotherapy or brain stimulation. Our MRI-compatible nasal delivery method enables the measurement of neural circuit responses to drug doses on a single-subject level, allowing the development of data-driven predictive models to quantify individual dysregulations of the reward control circuit causing addiction.
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Thomas KH, Davies NM, Taylor AE, Taylor GMJ, Gunnell D, Martin RM, Douglas I. Risk of neuropsychiatric and cardiovascular adverse events following treatment with varenicline and nicotine replacement therapy in the UK Clinical Practice Research Datalink: a case-cross-over study. Addiction 2021; 116:1532-1545. [PMID: 33197082 PMCID: PMC8246946 DOI: 10.1111/add.15338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/30/2019] [Accepted: 11/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Varenicline and nicotine replacement therapy (NRT) are the most commonly used medications to quit smoking. Given their widespread use, monitoring adverse risks remains important. This study aimed to estimate the neuropsychiatric and cardiovascular risks associated with varenicline and NRT as used in routine UK care. DESIGN Case-cross-over study. SETTING UK-based electronic primary care records in the Clinical Practice Research Datalink from 2006 to 2015 linked to hospital and mortality data sets. PARTICIPANTS Adult smokers (n =282,429) observed during periods when exposed and not exposed to either varenicline or NRT. MEASUREMENTS Main outcomes included suicide, self-harm, myocardial infarction (MI), all-cause death and cause-specific death [MI, chronic obstructive pulmonary disease (COPD)]. In primary analyses, conditional logistic regression was used to compare the chance of varenicline or NRT exposure during the risk period (90 days prior to the event) with the chance of exposure during an earlier single reference period (91-180 days prior to the event) or multiple 90-day reference periods to increase statistical power. FINDINGS In the primary analyses, findings were inconclusive for the associations between varenicline and the main outcomes using a single reference period, while NRT was associated with MI [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.18-1.67]. Using multiple reference periods, varenicline was associated with an increased risk of self-harm (OR = 1.32, 95% CI = 1.12-1.56) and suicide (OR = 3.56, 95% CI = 1.32-9.60) but a reduction in all-cause death (OR = 0.75, 95% CI = 0.61-0.93). NRT was associated with MI (OR = 1.54, 95% CI = 1.36-1.74), self-harm (OR = 1.30, 95% CI = 1.18-1.44) and deaths from MI (OR = 1.53, 95% CI = 1.11-2.10), COPD (OR = 1.33, 95% CI = 1.14-1.56) and all causes (OR = 1.28, 95% CI = 1.18-1.40) when using multiple reference periods. CONCLUSIONS There appear to be positive associations between (1) nicotine replacement therapy (NRT) and myocardial infarction, death and risk of self-harm and (2) varenicline and increased risk of self-harm and suicide, as well as a negative association between varenicline and all-cause death. The associations may not be causal. They may reflect health changes at the time of smoking cessation (nicotine replacement therapy is prescribed for people with cardiac problems) or be associated with quit attempts (exposure to both medicines was associated with self-harm).
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Affiliation(s)
- Kyla H. Thomas
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Neil M. Davies
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNUNorwegian University of Science and TechnologyNorway
| | - Amy E. Taylor
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Gemma M. J. Taylor
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - David Gunnell
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Richard M. Martin
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Ian Douglas
- Department of Non‐communicable Disease Epidemiology, Faculty of Epidemiology and Population HealthLSHTMLondonUK
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11
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Luehrs RE, Zhang D, Pierce GL, Jacobs DR, Kalhan R, Whitaker KM. Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study. J Am Heart Assoc 2021; 10:e019566. [PMID: 33902307 PMCID: PMC8200766 DOI: 10.1161/jaha.120.019566] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The associations of chronic cigarette smoking with blood pressure (BP) remain mixed. It is unclear whether a lack of examination of racial differences contributed to the mixed findings in previous studies. Black smokers metabolize nicotine at a slower rate than White smokers and racial discrimination contributes to nicotine dependence and higher BP among Black smokers. Methods and Results We studied the association between cigarette smoking and longitudinal (30‐year) changes in systolic BP, diastolic BP, and pulse pressure (PP) in 4786 Black and White individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study using repeated‐measures regression models. Neither systolic BP, nor diastolic BP differed between Black consistent smokers compared with Black never smokers, although Black consistent smokers had higher PP than Black never smokers (β=1.01 mm Hg, P=0.028). White consistent smokers had similar systolic BP, but lower diastolic BP (β=−2.27 mm Hg, P<0.001) and higher PP (β=1.59 mm Hg, P<0.001) compared with White never smokers. There were no differences in systolic BP, diastolic BP, or PP between Black or White long‐term former smokers compared with never smokers (all P>0.05). Conclusions Although the associations of cigarette smoking with alterations in BP are small, the greater PP observed in consistent smokers may contribute in part to the higher cardiovascular disease risk observed in this group because PP is a strong predictor of cardiovascular disease risk after middle age.
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Affiliation(s)
- Rachel E Luehrs
- Department of Health and Human Physiology The University of Iowa Iowa City IA.,Department of Kinesiology North Central College Naperville IL
| | - Dong Zhang
- Department of Health and Human Physiology The University of Iowa Iowa City IA
| | - Gary L Pierce
- Department of Health and Human Physiology The University of Iowa Iowa City IA.,Abboud Cardiovascular Research Center The University of Iowa Iowa City IA.,Environmental Health Sciences Research Center The University of Iowa Iowa City IA.,Fraternal Order of Eagles Diabetes Research Center The University of Iowa Iowa City IA
| | - David R Jacobs
- Division of Epidemiology and Community Health The University of Minnesota MN
| | - Ravi Kalhan
- Department of Medicine Northwestern University Chicago IL
| | - Kara M Whitaker
- Department of Health and Human Physiology The University of Iowa Iowa City IA.,Department of Epidemiology The University of Iowa Iowa City IA
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12
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Whitehead AK, Erwin AP, Yue X. Nicotine and vascular dysfunction. Acta Physiol (Oxf) 2021; 231:e13631. [PMID: 33595878 DOI: 10.1111/apha.13631] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
Cigarette smoking is the single most important risk factor for the development of cardiovascular diseases (CVDs). However, the role of nicotine, the addictive component of all tobacco products, in the development of CVD is incompletely understood. Although increased public awareness of the harms of cigarette smoking has successfully led to a decline in its prevalence, the use of electronic cigarettes (e-cig) or electronic nicotine delivery system has increased dramatically in recent years because of the perception that these products are safe. This review summarizes our current knowledge of the expression and function of the nicotinic acetylcholine receptors in the cardiovascular system and the impact of nicotine exposure on cardiovascular health, with a focus on nicotine-induced vascular dysfunction. Nicotine alters vasoreactivity through endothelium-dependent and/or endothelium-independent mechanisms, leading to clinical manifestations in both cigarette smokers and e-cig users. In addition, nicotine induces vascular remodelling through its effects on proliferation, migration and matrix production of both vascular endothelial and vascular smooth muscle cells. The purpose of this review is to identify critical knowledge gaps regarding the effects of nicotine on the vasculature and to stimulate continued nicotine research.
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Affiliation(s)
- Anna K. Whitehead
- Department of Physiology Louisiana State University Health Sciences Center New Orleans LA USA
| | - Abigail P. Erwin
- Department of Physiology Louisiana State University Health Sciences Center New Orleans LA USA
| | - Xinping Yue
- Department of Physiology Louisiana State University Health Sciences Center New Orleans LA USA
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13
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Morra S, Hossein A, Gorlier D, Rabineau J, Chaumont M, Migeotte PF, van de Borne P. Modification of the mechanical cardiac performance during end-expiratory voluntary apnea recorded with ballistocardiography and seismocardiography. Physiol Meas 2019; 40:105005. [PMID: 31579047 DOI: 10.1088/1361-6579/ab4a6a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess if micro-accelerometers and gyroscopes may provide useful information for the detection of breathing disturbances in further studies. APPROACH Forty-three healthy volunteers performed a 10 s end-expiratory breath-hold, while ballistocardiograph (BCG) and seismocardiograph (SCG) determined changes in kinetic energy and its integral over time (iK, J · s). BCG measures overall body accelerations in response to blood mass ejection into the main vasculature at each cardiac cycle, while SCG records local chest wall vibrations generated beat-by-beat by myocardial activity. This minimally intrusive technology assesses linear accelerations and angular velocities in 12 degrees of freedom to calculate iK during the whole cardiac cycle. iK produced during systole and diastole were also computed. MAIN RESULTS The iK during normal breathing was 87.1 [63.3; 132.8] µJ · s for the SCG and 4.5 [3.3; 6.2] µJ · s for the BCG. Both increased to 107.1 [69.0; 162.0] µJ · s and 6.1 [4.4; 9.0] µJ · s, respectively, during breath-holding (p = 0.003 and p < 0.0001, respectively). The iK of the SCG further increased during spontaneous respiration following apnea (from 107.1 [69.0; 162.0] µJ · s to 160.0 [96.3; 207.3] µJ · s, p < 0.0001). The ratio between the iK of diastole and systole increased from 0.35 [0.24; 0.45] during apnea to 0.49 [0.31; 0.80] (p < 0.0001) during the restoration of respiration. SIGNIFICANCE A brief voluntary apnea generates large and distinct increases in SCG and BCG waveforms. iK monitoring during sleep may prove useful for the detection of respiratory disturbances. ClinicalTrials.gov number: NCT03760159.
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Affiliation(s)
- Sofia Morra
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.,Author to whom any correspondence should be addressed
| | - Amin Hossein
- LPHYS, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Damien Gorlier
- LPHYS, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Martin Chaumont
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Philippe van de Borne
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Bruxelles, Belgium.,Both authors contributed equally
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14
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Hassanzadah M, Bitar AH, Khanfar NM, Khasawneh FT, Lutfy K, Shankar GS. A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs. Medicine (Baltimore) 2019; 98:e17375. [PMID: 31577741 PMCID: PMC6783193 DOI: 10.1097/md.0000000000017375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
Achieving abstinence in schizophrenic smokers using a combination of medications and cognitive behavioral therapy is feasible; however, abstinence rates are significantly lower compared to the general population and studies are scanty. Additionally, maintaining sustained abstinence and preventing relapse is a major limiting factor and represents key tasks in managing tobacco dependence in schizophrenic patients. Several theories have been postulated to explain the higher tendency of tobacco use among schizophrenic individuals. Schizophrenic patients may use nicotine as a "self-medication" strategy to improve negative symptoms of schizophrenia. However, studies suggest that although nicotine may act as an anxiolytic acutely, chronic use of nicotine may lead to increased anxiety with the possibility of increased catecholamines, which is confirmed with the prevalence of tachycardia and hypertension in smokers in general. On this basis, the main objective of our present study was to assess anxiety in schizophrenic smoking and nonsmoking patients by comparing the number of anxiety and agitation episodes and evaluating the amount of antianxiety/antiagitation medication used by each group. A separate objective was to document the unmet needs of smoking cessation programs in treating schizophrenic patients. Consequently, in the present retrospective cohort study, it was observed that schizophrenic smokers tend to have higher anxiety episodes and utilize as-needed medications at a higher frequency compared to nonsmokers for the relief of anxiety and agitation symptoms. Further research is warranted to examine these results on a larger scale.
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Affiliation(s)
| | - Adib H Bitar
- Aurora Charter Oak Behavioral Healthcare, Covina, CA
| | - Nile M Khanfar
- College of Pharmacy, Nova Southeastern University, Palm Beach, FL
| | - Fadi T Khasawneh
- School of Pharmacy, The University of Texas at El Paso, El Paso, TX
| | - Kabirullah Lutfy
- College of Pharmacy, Western University of Health Sciences, Pomona, CA
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15
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Price LR, Martinez J. Biological effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 09/07/2023] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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16
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Price LR, Martinez J. Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature. F1000Res 2019; 8:1586. [PMID: 32595938 PMCID: PMC7308884 DOI: 10.12688/f1000research.20062.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/14/2022] Open
Abstract
The emergence of new tobacco heating products and electronic nicotine delivery systems (ENDS) is changing the way humans are exposed to nicotine. The purpose of this narrative review is to provide a broad overview of published scientific literature with respect to the effects of nicotine on three key health-related areas: 1) cardiovascular risk, 2) carcinogenesis and 3) reproductive outcomes. These areas are known to be particularly vulnerable to the effects of cigarette smoke, and in addition, nicotine has been hypothesized to play a role in disease pathogenesis. Acute toxicity will also be discussed. The literature to February 2019 suggests that there is no increased cardiovascular risk of nicotine exposure in consumers who have no underlying cardiovascular pathology. There is scientific consensus that nicotine is not a direct or complete carcinogen, however, it remains to be established whether it plays some role in human cancer propagation and metastasis. These cancer progression pathways have been proposed in models in vitro and in transgenic rodent lines in vivo but have not been demonstrated in cases of human cancer. Further studies are needed to determine whether nicotine is linked to decreased fertility in humans. The results from animal studies indicate that nicotine has the potential to act across many mechanisms during fetal development. More studies are needed to address questions regarding nicotine exposure in humans, and this may lead to additional guidance concerning new ENDS entering the market.
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Affiliation(s)
- Leonie R. Price
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
| | - Javier Martinez
- Scientific and Regulatory Affairs, Japan Tobacco International, Genève, Genève, 1202, Switzerland
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17
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Cui J, Drew RC, Muller MD, Blaha C, Gonzalez V, Sinoway LI. Habitual cigarette smoking raises pressor responses to spontaneous bursts of muscle sympathetic nerve activity. Am J Physiol Regul Integr Comp Physiol 2019; 317:R280-R288. [PMID: 31091152 DOI: 10.1152/ajpregu.00293.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Smoking is a risk factor for cardiovascular diseases. Prior reports showed a transient increase in blood pressure (BP) following a spontaneous burst of muscle sympathetic nerve activity (MSNA). We hypothesized that this pressor response would be accentuated in smokers. Using signal-averaging techniques, we examined the BP (Finometer) response to MSNA in 18 otherwise healthy smokers and 42 healthy nonsmokers during resting conditions. The sensitivities of baroreflex control of MSNA and heart rate were also assessed. The mean resting MSNA, heart rate, and mean arterial pressure (MAP) were higher in smokers than nonsmokers. The MAP increase following a burst of MSNA was significantly greater in smokers than nonsmokers (Δ3.4 ± 0.3 vs. Δ1.6 ± 0.1 mmHg, P < 0.001). The baroreflex sensitivity (BRS) of burst incidence, burst area, or total activity was not different between the two groups. However, cardiac BRS was lower in smokers than nonsmokers (14.6 ± 1.7 vs. 24.6 ± 1.5 ms/mmHg, P < 0.001). Moreover, the MAP increase following a burst was negatively correlated with the cardiac BRS. These observations suggest that habitual smoking in otherwise healthy individuals raises the MAP increase following spontaneous MSNA and that the attenuated cardiac BRS in the smokers was a contributing factor. We speculate that the accentuated pressor increase in response to spontaneous MSNA may contribute to the elevated resting BP in the smokers.
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Affiliation(s)
- Jian Cui
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rachel C Drew
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew D Muller
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cheryl Blaha
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Virginia Gonzalez
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Lawrence I Sinoway
- Penn State Heart and Vascular Institute, Penn State Hershey, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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18
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Jung YA, Kang LL, Kim HN, Park HK, Hwang HS, Park KY. Relationship between Marital Status and Metabolic Syndrome in Korean Middle-Aged Women: The Sixth Korea National Health and Nutrition Examination Survey (2013-2014). Korean J Fam Med 2018; 39:307-312. [PMID: 29976034 PMCID: PMC6166117 DOI: 10.4082/kjfm.17.0020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/31/2017] [Indexed: 11/07/2022] Open
Abstract
Background This study aimed to investigate the relationship between marital status and the incidence of metabolic syndrome in Korean middle-aged women. Methods Based on data from the sixth Korea National Health and Nutrition Examination Survey (2013–2014), 3,225 women aged 40–69 years were subjected to the analysis. Marital status was categorized as married, unmarried, separated, widowed, or divorced. The odds ratios (ORs) for metabolic syndrome were calculated based on marital status. After adjustment for age, income level, education level, alcohol intake, smoking status, leisure physical activity, menopause status, daily calories, and fat intake, changes in the OR for metabolic syndrome based on marital status were examined by multivariate logistic regression analysis. Results The OR for metabolic syndrome in the widowed group to the married group was 4.818 (95% confidence interval [CI], 3.861–6.002; P<0.001) and that after adjustment of age, economic level, education level, alcohol intake, smoking status, physical activity, menopause status, total daily calories, and fat intake was 2.141 (CI, 1.432–3.199; P<0.001), both of which were statistically significant. The OR for metabolic syndrome in the unmarried group to the married group was 0.246 (CI, 0.141–0.431; P<0.001) after adjustment of all components. On the contrary, the ORs of the separated group and the divorced group to the married group were not significant. Conclusion In comparison with the married middle-aged group, the widowed middle-aged group tended to have a higher risk of metabolic syndrome, which is speculated to be related to socioeconomic factors and health behavior.
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Affiliation(s)
- Young-Ah Jung
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Li-Ly Kang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ha-Nui Kim
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea
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19
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Yasukochi Y, Sakuma J, Takeuchi I, Kato K, Oguri M, Fujimaki T, Horibe H, Yamada Y. Longitudinal exome-wide association study to identify genetic susceptibility loci for hypertension in a Japanese population. Exp Mol Med 2017; 49:e409;. [PMID: 29217820 PMCID: PMC5750474 DOI: 10.1038/emm.2017.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/01/2017] [Accepted: 06/12/2017] [Indexed: 01/11/2023] Open
Abstract
Genome-wide association studies have identified various genetic variants associated with complex disorders. However, these studies have commonly been conducted in a cross-sectional manner. Therefore, we performed a longitudinal exome-wide association study (EWAS) in a Japanese cohort. We aimed to identify genetic variants that confer susceptibility to hypertension using ~244 000 single-nucleotide variants (SNVs) and physiological data from 6026 Japanese individuals who underwent annual health check-ups for several years. After quality control, the association of hypertension with SNVs was tested using a generalized estimating equation model. Finally, our longitudinal EWAS detected seven hypertension-related SNVs that passed strict criteria. Among these variants, six SNVs were densely located at 12q24.1, and an East Asian-specific motif (haplotype) 'CAAAA' comprising five derived alleles was identified. Statistical analyses showed that the prevalence of hypertension in individuals with the East Asian-specific haplotype was significantly lower than that in individuals with the common haplotype 'TGGGT'. Furthermore, individuals with the East Asian haplotype may be less susceptible to the adverse effects of smoking on hypertension. The longitudinal EWAS for the recessive model showed that a novel SNV, rs11917356 of COL6A5, was significantly associated with systolic blood pressure, and the derived allele at the SNV may have spread throughout East Asia in recent evolutionary time.
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Affiliation(s)
- Yoshiki Yasukochi
- Department of Human Functional Genomics, Advanced Science Research Promotion Center, Mie University, Tsu, Japan.,CREST, Japan Science and Technology Agency, Kawaguchi, Japan
| | - Jun Sakuma
- CREST, Japan Science and Technology Agency, Kawaguchi, Japan.,Computer Science Department, College of Information Science, University of Tsukuba, Tsukuba, Japan.,RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
| | - Ichiro Takeuchi
- CREST, Japan Science and Technology Agency, Kawaguchi, Japan.,RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Department of Computer Science, Nagoya Institute of Technology, Nagoya, Japan
| | - Kimihiko Kato
- Department of Human Functional Genomics, Advanced Science Research Promotion Center, Mie University, Tsu, Japan.,Department of Internal Medicine, Meitoh Hospital, Nagoya, Japan
| | - Mitsutoshi Oguri
- Department of Human Functional Genomics, Advanced Science Research Promotion Center, Mie University, Tsu, Japan.,Department of Cardiology, Kasugai Municipal Hospital, Kasugai, Japan
| | - Tetsuo Fujimaki
- Department of Cardiovascular Medicine, Inabe General Hospital, Inabe, Japan
| | - Hideki Horibe
- Department of Cardiovascular Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yoshiji Yamada
- Department of Human Functional Genomics, Advanced Science Research Promotion Center, Mie University, Tsu, Japan.,CREST, Japan Science and Technology Agency, Kawaguchi, Japan
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20
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Li G, Wang H, Wang K, Wang W, Dong F, Qian Y, Gong H, Hui C, Xu G, Li Y, Pan L, Zhang B, Shan G. The association between smoking and blood pressure in men: a cross-sectional study. BMC Public Health 2017; 17:797. [PMID: 29017534 PMCID: PMC5634904 DOI: 10.1186/s12889-017-4802-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cigarette smoking is a known risk factor for cardiovascular disease (CVD), but the association between smoking and blood pressure is unclear. Thus, the current study examined the association between cigarette smoking and blood pressure in men. METHODS Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP) were examined using digital blood pressure measuring device, and smoking status was determined with China National Health Survey. RESULTS The ANCOVA showed that the adjusted DBP and MAP were lower in current smokers versus nonsmokers and the adjusted SBP was lower in current smokers versus former smokers (P < 0.05). Additionally, the adjusted PP tend to be decreased steadily as the pack·years increased in current smokers. In a fully adjusted logistic regression model, former smokers had increased ORs (95% CI) of 1.48 (1.01, 2.18) of hypertension and current smokers had not increased ORs (95% CI) of 0.83 (0.61, 1.12), compared with never smokers. CONCLUSIONS The findings revealed that the adjusted blood pressure were lower in current smokers versus nonsmokers and former smokers. No significant dose-dependent effect of current smoking on blood pressure indices except PP was observed. Smoking cessation was significantly associated with an increased risk of hypertension. However, current smoking was not a risk factor of hypertension.
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Affiliation(s)
- Guoju Li
- Qingdao Women and Children's Hospital, Qingdao University, Qingdao, Shandong, 266011, China
| | - Hailing Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Ke Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wenrui Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Fen Dong
- China-Japan Friendship Hospital, Beijing, China
| | - Yonggang Qian
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Haiying Gong
- Fangshan District Center for Disease Control and Prevention, Beijing, China
| | - Chunxia Hui
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, China
| | - Guodong Xu
- China-Japan Friendship Hospital, Beijing, China
| | - Yanlong Li
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Biao Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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21
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Al-Hariri MT, Elkilany AM, Alkahtani SA. Effects of potentially modifiable risk factors on the health of adults in the Eastern Province of KSA. J Taibah Univ Med Sci 2017; 13:16-21. [PMID: 31435298 PMCID: PMC6694929 DOI: 10.1016/j.jtumed.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/19/2023] Open
Abstract
Objectives The purpose of this study was to investigate the association between selected major modifiable risk factors including life style habits, household income and smoking on health. Methods This cross-sectional study was conducted during 2015-2016 among 104 healthy men aged 38 ± 8 years. The data were collected using a self-administered questionnaire that enquired about clinical information about blood pressure and body mass index. Venous blood samples were taken to assess the fasting blood glucose (FBG), lipid profile, high density lipoprotein and triglyceride. Results Current smoking status and consumed energy drinks were significantly positive risk factors for increased systolic blood pressure and FBG, respectively. Participants with monthly income of more than 10,000 Saudi Riyals showed significantly lower diastolic pressure than those with lower income. However, there was a significant decrease in body weight among those who consumed vegetables. Conclusion This study highlights the effect of major modifiable risk factors on health. There is a great need for improving and enhancing a healthy lifestyle behaviour.
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Affiliation(s)
- Mohammed T Al-Hariri
- Department of Physiology, College of Medicine, University of Dammam, Dammam, KSA
| | - Ahmed M Elkilany
- Department of Physical & Health Education, College of Preparatory Year & Supporting Studies, University of Dammam, Dammam, KSA
| | - Shaea A Alkahtani
- Department of Exercise Physiology, College of Sport Sciences and Physical Activity, King Saud University, KSA
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22
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Hansen EØ, Arendt-Nielsen L, Boudreau SA. A Comparison of Oral Sensory Effects of Three TRPA1 Agonists in Young Adult Smokers and Non-smokers. Front Physiol 2017; 8:663. [PMID: 28936178 PMCID: PMC5594084 DOI: 10.3389/fphys.2017.00663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 08/21/2017] [Indexed: 01/28/2023] Open
Abstract
This study profiled intra-oral somatosensory and vasomotor responses to three different transient receptor potential (TRP) channels, subfamily A, member 1 (TRPA1) agonists (menthol, nicotine, and cinnamaldehyde) in smoking and non-smoking young adults. Healthy non-smokers (N = 30) and otherwise healthy smokers (N = 25) participated in a randomized, double-blinded, cross-over study consisting of three experimental sessions in which they received menthol (30 mg), nicotine (4 mg), or cinnamaldehyde (25 mg) chewing gum. Throughout a standardized 10 min chewing regime, burning, cooling, and irritation intensities, and location were recorded. In addition, blood pressure, heart rate and intra-oral temperature were assessed before, during, and after chewing. Basal intra-oral temperature was lower in smokers (35.2°C ± 1.58) as compared to non-smokers (35.9°C ± 1.61) [F(1, 52) = 8.5, P = 0.005, post hoc, p = 0.005]. However, the increase in temperature, heart rate, and blood pressure in response to chewing menthol, nicotine, and cinnamaldehyde gums were similar between smokers and non-smokers. Although smoking status did not influence the intensity of burning, cooling, and irritation, smokers did report nicotine burn more often (92%) than non-smokers (63%) [χ(1, N=55)2 = 6.208, P = 0.013]. Reports of nicotine burn consistently occurred at the back of the throat and cinnamaldehyde burn on the tongue. The cooling sensation of menthol was more widely distributed in the mouth of non-smokers as compared to smokers. Smoking alters thermoregulation, somatosensory, and possibly TRPA1 receptor responsiveness and suggests that accumulated exposure of nicotine by way of cigarette smoke alters oral sensory and vasomotor sensitivity.
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Affiliation(s)
- Eva Ø Hansen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg UniversityAalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg UniversityAalborg, Denmark
| | - Shellie A Boudreau
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg UniversityAalborg, Denmark
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23
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Kim C, Kim M, Jung H, Kim M. Effects of exercise training intensity on cardiac autonomic regulation in habitual smokers. Ann Noninvasive Electrocardiol 2017; 22:e12434. [PMID: 28247979 PMCID: PMC6931629 DOI: 10.1111/anec.12434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/28/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The sympathoexcitatory effects of cigarette smoking cause an autonomic imbalance that may lead to cardiovascular disease. Aerobic training improves autonomic function by developing cardiorespiratory fitness; however, it is still uncertain whether aerobic training ameliorates the compromised autonomic modulation in smokers. This study aimed to investigate the effects of 8 weeks' aerobic training at different exercise intensities on autonomic regulation in habitual smokers. METHODS Healthy males (n = 34) were randomly assigned to a moderate-intensity aerobic training (MAT, 60% of heart rate reserve [HRR]), a high-intensity training group (HAT, 75% HRR), or a control group (CG). Training groups performed 8 weeks' aerobic training on a treadmill (3 times/week), but all subjects continued to smoke cigarettes as usual. Heart rate variability was monitored to evaluate the effect of aerobic training on autonomic regulation. RESULTS Aerobic training improved autonomic balance despite the continued smoking. In the time domain, rMSSD and pNN50 were significantly increased in HAT than in CG. On spectral analysis, the absolute and normalized units of high frequency (HF) were significantly increased in HAT, whereas the LF/HF ratio and the normalized unit of LF were significantly decreased compared to that in CG. SD1 and the SD1/SD2 ratio of the Poincaré plot analysis were significantly increased compared to CG. Although MAT showed a similar tendency to HAT in nonlinear indexes, there were no significant differences compared to CG. CONCLUSION Aerobic training, particularly high-intensity training, increases the parasympathetic contribution to the sympathovagal system, leading to an improvement in autonomic balance despite continued cigarette smoking.
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Affiliation(s)
- Choun‐Sub Kim
- Sports Medicine Lab. Department of Physical EducationKyungpook National UniversityDae‐guSouth Korea
| | - Maeng‐Kyu Kim
- Sports Medicine Lab. Department of Physical EducationKyungpook National UniversityDae‐guSouth Korea
| | - Hye‐Young Jung
- Sports Medicine Lab. Department of Physical EducationKyungpook National UniversityDae‐guSouth Korea
| | - Mi‐Ji Kim
- Division of Geriatric MedicineEast‐West Medical Research InstituteKyung Hee UniversitySeoulSouth Korea
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D'Ruiz CD, O'Connell G, Graff DW, Yan XS. Measurement of cardiovascular and pulmonary function endpoints and other physiological effects following partial or complete substitution of cigarettes with electronic cigarettes in adult smokers. Regul Toxicol Pharmacol 2017; 87:36-53. [PMID: 28476553 DOI: 10.1016/j.yrtph.2017.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/31/2017] [Accepted: 05/01/2017] [Indexed: 12/20/2022]
Abstract
Acute changes in select physiological parameters associated with cardiovascular physiology (systolic and diastolic blood pressure (BP) and heart rate (HR)), pulmonary function (FVC, FEV1, and exhaled CO and NO) and adverse events were measured in 105 clinically confined subjects who were randomized into groups that either completely or partially switched from conventional cigarettes to e-cigarettes or completely discontinued using tobacco and nicotine products altogether. Use of the e-cigarettes for five days under the various study conditions did not lead to higher BP or HR values, negative respiratory health outcomes or serious adverse health events. Reductions in BP and HR vital signs were observed in most of the participants that either ceased tobacco and nicotine products use altogether or switched completely to using e-cigarettes. Pulmonary function tests showed small but non-statistically significant improvements in FVC and FEV1 measurements in most use groups. Statistically significant (p < 0.05) benefits associated with smoking reduction were also noted in exhaled CO and NO levels. All study products were well tolerated. The study findings suggest that there are potential cardiovascular and pulmonary function benefits when smokers switch to using e-cigarette products. This further reinforces the potential that e-cigarettes offer smokers seeking an alternative to conventional tobacco products.
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Affiliation(s)
- Carl D D'Ruiz
- Clinical Study Consultant, Fontem Ventures, Greensboro, NC, USA.
| | - Grant O'Connell
- Fontem Ventures, Scientific and Regulatory Affairs, Amsterdam, The Netherlands.
| | | | - X Sherwin Yan
- Lorillard Tobacco Company (formerly), Greensboro, NC, USA.
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25
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Dollerup J, Vestbo J, Murray-Thomas T, Kaplan A, Martin RJ, Pizzichini E, Pizzichini MMM, Burden A, Martin J, Price DB. Cardiovascular risks in smokers treated with nicotine replacement therapy: a historical cohort study. Clin Epidemiol 2017; 9:231-243. [PMID: 28490903 PMCID: PMC5413486 DOI: 10.2147/clep.s127775] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Previous research suggests exposure to nicotine replacement therapy (NRT) may be associated with an increased risk of cardiovascular disease (CVD). Methods Using data from the United Kingdom’s Clinical Practice Research Datalink, this study aimed to evaluate CVD events and survival among individuals who attempted smoking cessation with the support of NRT compared with those aided by smoking cessation advice only. We studied CVD outcomes over 4 and 52 weeks in 50,214 smokers attempting to quit – 33,476 supported by smoking cessation advice and 16,738 with the support of NRT prescribed by their primary care physician. Patients were matched (2 smoking cessation advice patients:1 NRT patient) on demographic and clinical characteristics during a baseline year preceding their quit attempt. Cox proportional hazard regression, conditional negative binomial regression model, and conditional logistic regression were used to analyze data. Results Mean (standard deviation) population age was 47 (11.2) years; 51% were females. Time to first diagnosis of ischemic heart disease (IHD) among NRT and smoking cessation advice patients was similar within the first 4 weeks, but shorter for NRT patients over 52 weeks (hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.03–1.77). A similar trend was observed for cerebrovascular disease (HR: 1.54, 95% CI: 1.08–2.19). NRT patients with a prior diagnosis of IHD or cerebrovascular disease had a higher rate of primary or secondary care consultations for IHD or cerebrovascular disease by 52 weeks (rate ratio: 1.50, 95% CI: 1.14–1.99). Patients prescribed NRT had a shorter survival time over 52 weeks, compared with those receiving advice only (HR: 1.39, 95% CI: 1.09–1.76). Conclusion Our findings suggest that treatment with NRT over 4 weeks does not appear to have an impact on cardiovascular risks. However, a longer follow-up period of 52 weeks resulted in an increase in cardiovascular events for patients prescribed NRT, compared with those receiving smoking cessation advice only.
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Affiliation(s)
- Jens Dollerup
- Dollerup Medical Consultancy, Kongens Lyngby, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Tarita Murray-Thomas
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| | - Alan Kaplan
- Family Physician Airways Group of Canada, Richmond Hill, ON, Canada
| | | | | | | | - Anne Burden
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Jessica Martin
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore.,Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review. J Hypertens 2017; 35:421-441. [PMID: 27977471 PMCID: PMC5278896 DOI: 10.1097/hjh.0000000000001197] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/13/2016] [Accepted: 11/05/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND To interpret blood pressure (BP) data appropriately, healthcare providers need to be knowledgeable of the factors that can potentially impact the accuracy of BP measurement and contribute to variability between measurements. METHODS A systematic review of studies quantifying BP measurement inaccuracy. Medline and CINAHL databases were searched for empirical articles and systematic reviews published up to June 2015. Empirical articles were included if they reported a study that was relevant to the measurement of adult patients' resting BP at the upper arm in a clinical setting (e.g. ward or office); identified a specific source of inaccuracy; and quantified its effect. Reference lists and reviews were searched for additional articles. RESULTS A total of 328 empirical studies were included. They investigated 29 potential sources of inaccuracy, categorized as relating to the patient, device, procedure or observer. Significant directional effects were found for 27; however, for some, the effects were inconsistent in direction. Compared with true resting BP, significant effects of individual sources ranged from -23.6 to +33 mmHg SBP and -14 to +23 mmHg DBP. CONCLUSION A single BP value outside the expected range should be interpreted with caution and not taken as a definitive indicator of clinical deterioration. Where a measurement is abnormally high or low, further measurements should be taken and averaged. Wherever possible, BP values should be recorded graphically within ranges. This may reduce the impact of sources of inaccuracy and reduce the scope for misinterpretations based on small, likely erroneous or misleading, changes.
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Affiliation(s)
- Noa Kallioinen
- School of Psychology, The University of Queensland, St. Lucia
| | - Andrew Hill
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
| | | | - Helen E. Ward
- The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside
| | - Marcus O. Watson
- School of Psychology, The University of Queensland, St. Lucia
- Clinical Skills Development Service, Metro North Hospital and Health Service, Herston
- School of Medicine, The University of Queensland Mayne Medical School, Herston, Queensland, Australia
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Prevalence of concealed and overt chronic renal failure in patients with COPD. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Correlates and Outcomes of Posttransplant Smoking in Solid Organ Transplant Recipients. Transplantation 2016; 100:2252-2263. [DOI: 10.1097/tp.0000000000001335] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferreira VM, Passos CS, Maquigussa E, Pontes RB, Bergamaschi CT, Campos RR, Boim MA. Chronic Nicotine Exposure Abolishes Maternal Systemic and Renal Adaptations to Pregnancy in Rats. PLoS One 2016; 11:e0150096. [PMID: 26914675 PMCID: PMC4768004 DOI: 10.1371/journal.pone.0150096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Pregnancy is characterized by maternal systemic and intrarenal vasodilation, leading to increases in the renal plasma flow (RPF) and glomerular filtration rate (GFR). These responses are mainly mediated by nitric oxide (NO) and relaxin. The impact of cigarette smoking on the maternal adaptations to pregnancy is unclear. Here we evaluated the effects of chronic exposure to nicotine on systemic and intrarenal parameters in virgin (V) and 14-day pregnant (P) Wistar rats. V and P groups received saline or nicotine (6 mg·kg-1·day-1) respectively, via osmotic minipumps for 28 days, starting 14 days before pregnancy induction. Nicotine induced a 10% increase in blood pressure in the V group and minimized the characteristic pregnancy-induced hypotension. Renal sympathetic nerve activity (rSNA) and baroreflex sensitivity were impaired by nicotine mainly in the P group, indicating that the effect of nicotine on blood pressure was not mediated by nervous system stimulation. Nicotine had no effect on GFR in the V rats but reduced GFR of the P group by 30%. Renal expression of sodium and water transporters was downregulated by nicotine, resulting in increased fractional sodium excretion mainly in the P group, suggesting that nicotine compromised the sodium and water retention required for normal gestation. There was a reduction in the expression of inducible NO synthase (iNOS) in both the kidney tissue and renal artery, as well as in the expression of the relaxin receptor (LGR7). These results clearly show that nicotine induced deleterious effects in both virgin and pregnant animals, and abolished the maternal capacity to adapt to pregnancy.
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Affiliation(s)
- Vanessa Meira Ferreira
- Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Clevia Santos Passos
- Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Edgar Maquigussa
- Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Roberto Braz Pontes
- Cardiovascular Division, Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Cassia Toledo Bergamaschi
- Cardiovascular Division, Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Ruy Ribeiro Campos
- Cardiovascular Division, Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Mirian Aparecida Boim
- Renal Division, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- * E-mail:
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Silva AP, Scholz J, Abe TO, Pinheiro GG, Gaya PV, Pereira AC, Santos PCJL. Influence of smoking cessation drugs on blood pressure and heart rate in patients with cardiovascular disease or high risk score: real life setting. BMC Cardiovasc Disord 2016; 16:2. [PMID: 26728720 PMCID: PMC4700597 DOI: 10.1186/s12872-015-0180-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/21/2015] [Indexed: 11/14/2022] Open
Abstract
Background Smoking is the most important reversible cardiovascular risk factor. It is well established that quitting smoking reduces coronary events. However, on several occasions, the cardiovascular safety of smoking cessation drugs has been questioned. Our goal is to evaluate the effects of smoking cessation drugs on blood pressure and heart rate in patients from a smoking cessation service in a cardiology hospital. Methods We examined the PAF database (Smoking Cessation Assistance Program database) between January 2008 and March 2014. We analyzed data from 900 patients who were compliant with the treatment (50.5 % male, average age 53 ± 17 years). The most frequent clinical diagnoses were coronary artery disease (25.2 %), hypertension (57.2 %), and diabetes (13.4 %). Blood pressure, heart rate, and carbon monoxide (CO) concentration in exhaled air were analyzed at consecutive visits during the first 45 days of treatment (mean visits - 3). Analysis of repeated measures was used for the statistical analysis (p < 0.05). Results Two hundred seventy one patients used nicotine replacement therapy (NRT) alone, 81 used bupropion alone, 154 used varenicline alone, 283 used NRT plus bupropion and 111 used bupropion plus varenicline. For all smoking cessation drugs, used alone or in combination, no increase occurred in the average value of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Significant reductions in CO concentrations occurred in all smoking cessation drug groups. Conclusion Smoking cessation drugs used in monotherapy or in combined regimens did not influence systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in this group of patients during the observation period.
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Affiliation(s)
| | - Jaqueline Scholz
- Smoking Cessation Program Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar 44, Cerqueira Cesar, 05403-900, Sao Paulo, SP, Brazil.
| | - Tania Ogawa Abe
- Smoking Cessation Program Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar 44, Cerqueira Cesar, 05403-900, Sao Paulo, SP, Brazil
| | | | | | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Guillot CR, Stone MD, Geary BA, Kirkpatrick MG, Tidey JW, Cook JW, Leventhal AM. Pharmacological, sensorimotor, and expectancy effects on tobacco withdrawal: a preliminary study. Hum Psychopharmacol 2015; 30:364-71. [PMID: 26010521 PMCID: PMC4565749 DOI: 10.1002/hup.2484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Research designs for parsing the mechanisms underlying tobacco withdrawal are scant. This study introduced a novel research design that simultaneously manipulated three tobacco withdrawal mechanisms: pharmacological (nicotine dissipation), sensorimotor (elimination of the smoking ritual), and expectancy (activation of beliefs regarding the effects of nicotine deprivation), permitting examination of the effects of each mechanism while holding the other two mechanisms constant. METHODS Following overnight abstinence, 32 regular cigarette smokers were randomized in a 2 (expectancy: told patch contains nicotine versus told placebo patch) × 2 (drug: receive 21-mg transdermal nicotine patch versus receive placebo patch) × 2 (sensorimotor: smoke very low nicotine content cigarettes versus no smoking) full factorial between-subjects design. Participants repeatedly completed measures of craving, affect, and anticipated pleasure from and desire for rewarding experiences, followed by a smoking lapse analog task. RESULTS Receiving nicotine (versus placebo) increased positive affect and anticipated pleasure from and desire for reward. Expecting nicotine (versus placebo) reduced negative affect and increased smoking delay. Sensorimotor stimulation from smoking (versus no smoking) reduced smoking urge and behavior. CONCLUSION Results provided initial validation of this novel three-mechanism design. This design can be used in the future to advance understanding and treatment of tobacco withdrawal.
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Affiliation(s)
- Casey R. Guillot
- Department of Preventive Medicine, University of Southern
California,Corresponding author: Casey R. Guillot, University of
Southern California, Department of Preventive Medicine, 2001 N Soto St, SSB 3
Floor, Los Angeles, CA 90032-9045; Tel: 323-442-8218; Fax: 323-442-2359;
| | - Matthew D. Stone
- Department of Preventive Medicine, University of Southern
California
| | - Bree A. Geary
- Department of Preventive Medicine, University of Southern
California
| | | | | | - Jessica W. Cook
- University of Wisconsin-Madison School of Medicine and Public
Health
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern
California,Department of Psychology, University of Southern California
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Middlekauff HR, Park J, Moheimani RS. Adverse effects of cigarette and noncigarette smoke exposure on the autonomic nervous system: mechanisms and implications for cardiovascular risk. J Am Coll Cardiol 2015; 64:1740-50. [PMID: 25323263 DOI: 10.1016/j.jacc.2014.06.1201] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 11/27/2022]
Abstract
This review summarizes the detrimental effects of cigarette and noncigarette emission exposure on autonomic function, with particular emphasis on the mechanisms of acute and chronic modulation of the sympathetic nervous system. We propose that the nicotine and fine particulate matter in tobacco smoke lead to increased sympathetic nerve activity, which becomes persistent via a positive feedback loop between sympathetic nerve activity and reactive oxidative species. Furthermore, we propose that baroreflex suppression of sympathetic activation is attenuated in habitual smokers; that is, the baroreflex plays a permissive role, allowing sympathoexcitation to occur without restraint in the setting of increased pressor response. This model is also applicable to other nontobacco cigarette emission exposures (e.g., marijuana, waterpipes [hookahs], electronic cigarettes, and even air pollution). Fortunately, emerging data suggest that baroreflex sensitivity and autonomic function may be restored after smoking cessation, providing further evidence in support of the health benefits of smoking cessation.
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Affiliation(s)
- Holly R Middlekauff
- Division of Cardiology, Department of Medicine, University of California-Los Angeles, Los Angeles, California.
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, and the Veterans Affairs Medical Center, Atlanta, Georgia
| | - Roya S Moheimani
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
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Chagué F, Guenancia C, Gudjoncik A, Moreau D, Cottin Y, Zeller M. Smokeless tobacco, sport and the heart. Arch Cardiovasc Dis 2014; 108:75-83. [PMID: 25497687 DOI: 10.1016/j.acvd.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 11/24/2022]
Abstract
Smokeless tobacco (snuff) is a finely ground or shredded tobacco that is sniffed through the nose or placed between the cheek and gum. Chewing tobacco is used by putting a wad of tobacco inside the cheek. Smokeless tobacco is widely used by young athletes to enhance performance because nicotine improves some aspects of physiology. However, smokeless tobacco has harmful health effects, including cardiovascular disorders, linked to nicotine physiological effects, mainly through catecholamine release. Nicotine decreases heart rate variability and the ventricular fibrillation threshold, and promotes the occurrence of various arrhythmias; it also impairs endothelial-dependent vasodilation and could therefore promote premature atherogenesis. At rest, heart rate, blood pressure, inotropism, cardiac output and myocardial oxygen consumption are increased by nicotine, leading to an imbalance between myocardial oxygen demand and supply. The same occurs at submaximal levels of exercise. These increases are accompanied by a rise in systemic resistances. At maximal exercise, heart rate, cardiac output and maximal oxygen uptake (V˙O2max) are unaffected by nicotine. Because endothelial dysfunction is promoted by nicotine, paradoxical coronary vasoconstriction may occur during exercise and recovery. Nicotine induces a decrease in muscular strength and impairs anaerobic performance. However, nicotine is used in sports as it diminishes anxiety, enhances concentration and agility, improves aerobic performance and favours weight control. Importantly, smokeless tobacco, similar to cigarette smoking, leads to nicotine dependence through dopaminergic pathways. Smokeless tobacco has harmful cardiovascular effects and is addictive: it fulfils all the criteria for inclusion in the World Anti-Doping Agency prohibited list as a doping product. Smokeless tobacco use in sporting activities must be discouraged.
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Affiliation(s)
| | - Charles Guenancia
- Cardiology Department, CHU de Dijon, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France
| | | | - Daniel Moreau
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France
| | - Yves Cottin
- Cardiology Department, CHU de Dijon, Dijon, France; Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France
| | - Marianne Zeller
- Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France.
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Palazzolo DL. Electronic cigarettes and vaping: a new challenge in clinical medicine and public health. A literature review. Front Public Health 2013; 1:56. [PMID: 24350225 PMCID: PMC3859972 DOI: 10.3389/fpubh.2013.00056] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/01/2013] [Indexed: 01/04/2023] Open
Abstract
Electronic cigarette (e-cigarette) use, or vaping, in the United States and worldwide is increasing. Their use is highly controversial from scientific, political, financial, psychological, and sociological ideologies. Given the controversial nature of e-cigarettes and vaping, how should medical care providers advise their patients? To effectively face this new challenge, health care professionals need to become more familiar with the existing literature concerning e-cigarettes and vaping, especially the scientific literature. Thus, the aim of this article is to present a review of the scientific evidence-based primary literature concerning electronic cigarettes and vaping. A search of the most current literature using the pubmed database dating back to 2008, and using electronic cigarette(s) or e-cigarette(s) as key words, yielded a total of 66 highly relevant articles. These articles primarily deal with (1) consumer-based surveys regarding personal views on vaping, (2) chemical analysis of e-cigarette cartridges, solutions, and mist, (3) nicotine content, delivery, and pharmacokinetics, and (4) clinical and physiological studies investigating the effects of acute vaping. When compared to the effects of smoking, the scant available literature suggests that vaping could be a “harm reduction” alternative to smoking and a possible means for smoking cessation, at least to the same degree as other Food and Drug Administration-approved nicotine replacement therapies. However, it is unclear if vaping e-cigarettes will reduce or increase nicotine addiction. It is obvious that more rigorous investigations of the acute and long-term health effects of vaping are required to establish the safety and efficacy of these devices; especially parallel experiments comparing the cardiopulmonary effects of vaping to smoking. Only then will the medical community be able to adequately meet the new challenge e-cigarettes and vaping present to clinical medicine and public health.
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Affiliation(s)
- Dominic L Palazzolo
- Department of Physiology and Pharmacology, DeBusk College of Osteopathic Medicine, Lincoln Memorial University , Harrogate, TN , USA
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The influence of acutely administered nicotine on cue-induced craving for gambling in at-risk video lottery terminal gamblers who smoke. Behav Pharmacol 2013; 24:124-32. [PMID: 23412113 DOI: 10.1097/fbp.0b013e32835f3cff] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence indicates that tobacco use and gambling often co-occur. Despite this association, little is known about how tobacco use affects the propensity to gamble. Nicotine, the putative addictive component of tobacco, has been reported to potentiate the hedonic value of other nonsmoking stimuli. Environmental cues have been identified as an important contributor to relapse in addictive behavior; however, the extent to which nicotine can affect the strength of gambling cues remains unknown. This study examined whether nicotine influences subjective ratings for gambling following gambling cues. In a mixed within/between-subjects design, 30 (20 men) video lottery terminal (VLT) gamblers ('moderate-risk' or 'problem' gamblers) who smoke daily were assigned to nicotine (4 mg deliverable) or placebo lozenge conditions. Subjective and behavioral responses were assessed at baseline, following lozenge, following neutral cues, and following presentation of gambling cues. Nicotine lozenge was found to significantly reduce tobacco-related cravings (P<0.05) but did not affect gambling-related cravings, the choice to play a VLT, or other subjective responses. These results suggest that a low dose of acutely administered nicotine does not increase cue-induced craving for gambling in at-risk VLT gamblers who smoke.
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Knight DR, Smith AH, Schroeder RL, Huang C, Beebe DA, Sokolowski SA, Wang M. Effects of age on noninvasive assessments of vascular function in nonhuman primates: implications for translational drug discovery. J Transl Med 2013; 11:101. [PMID: 23607770 PMCID: PMC3644259 DOI: 10.1186/1479-5876-11-101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 04/09/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Endothelium-dependent flow mediated dilation (FMD) and pulse-wave velocity (PWV), are used as measures of vascular health and predictors of cardiovascular risk in clinical studies, and both are age-dependent. Numbers of circulating endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) are also associated with cardiovascular risk, but independent of age in humans. The use of these measurements for pre-clinical assessment of drug cardiovascular safety and efficacy in non-human primates (NHPs) may promote the translation of drug-induced effects on vascular function to clinic outcomes. However, in NHPs, the age effects on the non-invasive measurements of FMD and PWV and the relationship of EMPs/EPCs with FMD are unknown. METHODS A non-invasive, clinically-relevant approach to assess FMD and PWV was used to examine their relationship with age and with EMPs/EPCs in NHPs. The effects on FMD of nicotine and rosiglitazone were evaluated in senescent primates in an effort to validate our FMD method for pre-clinical assessment of vascular function. RESULTS FMD and PWV methods were established in a colony (n = 25) of metabolically healthy, cynomolgus monkeys ranging in age from 6 to 26 years. FMD, defined as the percent change, at 1 min of cuff release, from baseline vascular diameter (0.15 ± 0.03 cm), had a strong, negative correlation with age (r = -0.892, p < 0.0001), ranging from 6% to 33%. PWV positively correlated with age (r = 0.622, p < 0.002) in the same healthy monkeys. Nicotine and rosiglitazone, were evaluated in subsets of senescent primates (mean age 16.3 ± 1.5[SEM] years). Rosiglitazone significantly improved FMD (21.0 ± 1.6% vs. vehicle 16.3 ± 1.6%, p < 0.01) without changing baseline diameters, and coincided with a significant increase in circulating numbers of endothelial progenitor cells (CD45-CD31 + CD34 + VEGFR2+ 7.1 ± 1.3 vs. 4.8 ± 1.1 counts/μl) and a decrease in endothelial microparticles (CD45-CD42a-CD54+ 26.7 ± 11.1 vs. 62.2 ± 9.8 counts/μl)(p < 0.05). Conversely, FMD was significantly reduced with nicotine (8.7 ± 1.4% vs. vehicle 20.1 ± 2.2%, p < 0.05). CONCLUSIONS Adult NHPs demonstrate the characteristic linear relationship between age and vascular function using the non-invasive clinically-related measurements of FMD and PWV. However, numbers of circulating EMPs and EPCs did not correlate with age. Endothelial function assessed with FMD, together with EMPs/EPCs assessment, may serve as a novel approach for translational research and therapeutic discovery. Age should be considered in the study design or data analyses when FMD or PWV is used in NHPs.
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Affiliation(s)
- Delvin R Knight
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - Andrew H Smith
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - Richard L Schroeder
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - Chunli Huang
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - David A Beebe
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - Sharon A Sokolowski
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
| | - Miao Wang
- Pfizer Worldwide Research and Development, Cardiovascular and Metabolic Diseases Research Unit, Pfizer Inc, Groton, CT 06340, USA
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Wang W, Pan Y, Li Q, Wang L. Orexin: a potential role in the process of obstructive sleep apnea. Peptides 2013; 42:48-54. [PMID: 23313149 DOI: 10.1016/j.peptides.2013.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnea (OSA) is a complicated disease with an unrecognized mechanism. Obesity, sex, age, and smoking have been found to be independent correlates of OSA. Orexin (also named hypocretin) mainly secreted by lateral hypothalamus neurons has a wide array of biological functions like regulating sleep, energy levels and breathing. Several clinical studies found ties between orexin and OSA. Because of the close correlation between orexin and obesity, sex, age and smoking (which are the key risk factors for OSA patients), we hypothesize that orexin may play a key role in the pathogenesis of OSA.
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Affiliation(s)
- Wei Wang
- Institute of Stomatology, Nanjing Medical University, Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China
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Sobieraj DM, White WB, Baker WL. Cardiovascular effects of pharmacologic therapies for smoking cessation. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2013; 7:61-7. [PMID: 23266101 PMCID: PMC3549329 DOI: 10.1016/j.jash.2012.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/29/2012] [Accepted: 11/07/2012] [Indexed: 11/26/2022]
Abstract
Tobacco dependence is a potent risk factor for cardiovascular (CV) diseases and, despite known harms of smoking and benefits associated with smoking cessation, approximately 20% of the adult population with CV diseases or hypertension continue to smoke. Extensive research has demonstrated that nicotine replacement, varenicline, and bupropion sustained-release are superior to placebo for short- and intermediate-term smoking cessation. Because of their mechanisms of action, some smoking cessation therapies have been thought to have the potential to increase CV risk, particularly if the pharmacotherapies are taken while individuals are still smoking. Hence, we have analytically reviewed the literature describing the CV effects of therapies for smoking cessation, particularly as they apply to patients with CV disease.
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Affiliation(s)
- Diana M. Sobieraj
- University of Connecticut Schools of Pharmacy, Storrs and Farmington, CT
| | - William B. White
- Medicine, Storrs and Farmington, CT
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, Farmington, CT
| | - William L. Baker
- University of Connecticut Schools of Pharmacy, Storrs and Farmington, CT
- Medicine, Storrs and Farmington, CT
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Woolf KJ, Bisognano JD. Nondrug interventions for treatment of hypertension. J Clin Hypertens (Greenwich) 2011; 13:829-835. [PMID: 22051428 PMCID: PMC8112377 DOI: 10.1111/j.1751-7176.2011.00524.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 01/05/2024]
Abstract
The treatment of hypertension is no longer limited to the simple prescription of pharmaceuticals. For many patients, maximal medical therapy is insufficient to adequately treat refractory hypertension. In addition, some patients may prefer to explore therapies that do not involve drugs as an initial step. Utilizing our broadening understanding of the physiology of hypertension, new technology and interventions have been developed that allow for treatments that do not rely on medications. In addition, dietary supplements and modification, as well as herbal supplements, may be useful under the right circumstances. Lifestyle modification remains a necessary part of treatment for all patients with hypertension. This article will review the evidence behind some available nondrug interventions for the treatment of hypertension.
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Affiliation(s)
- Kevin J. Woolf
- From the Division of Cardiology, University of Rochester Medical Center, Rochester, NY
| | - John D. Bisognano
- From the Division of Cardiology, University of Rochester Medical Center, Rochester, NY
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Nicotine replacement therapy in critically ill patients: a prospective observational cohort study. Crit Care Med 2011; 39:1635-40. [PMID: 21494111 DOI: 10.1097/ccm.0b013e31821867b8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent nicotine withdrawal. However, recent studies have questioned the safety of this practice. The objective of this study was to determine the impact of nicotine replacement therapy on the outcomes of critically ill patients. DESIGN Prospective observational cohort. SETTING The medical intensive care unit of a tertiary academic hospital. PATIENTS Active smokers admitted to the intensive care unit. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After excluding 2,411 patients who did not meet the study inclusion criteria, 330 were included in the study, of which 174 patients received and 156 did not receive nicotine replacement therapy. There were no significant differences in the unadjusted hospital mortality between the two groups: 14 patients (7.8%; 95% confidence interval, 4-12) died in the nicotine replacement therapy group as compared with ten patients (6.3%; 95% confidence interval, 2.6-10.3) in the nonnicotine replacement therapy group (p = .59). After adjusting for severity of illness and propensity score for administration of nicotine replacement therapy on intensive care unit admission, nicotine replacement therapy was not associated with increased hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.5-3.9; p = .51). LIMITATIONS Single-center observational study. CONCLUSIONS Nicotine replacement therapy is not associated with increased hospital mortality in critically ill patients. However, we were not able to demonstrate any clinically significant benefit from its use in the intensive care unit setting.
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Richards JM, Stipelman BA, Bornovalova MA, Daughters SB, Sinha R, Lejuez CW. Biological mechanisms underlying the relationship between stress and smoking: state of the science and directions for future work. Biol Psychol 2011; 88:1-12. [PMID: 21741435 DOI: 10.1016/j.biopsycho.2011.06.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 03/07/2011] [Accepted: 06/22/2011] [Indexed: 01/01/2023]
Abstract
Theories of addiction implicate stress as a crucial mechanism underlying initiation, maintenance, and relapse to cigarette smoking. Examinations of the biological stress systems, including functioning of the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), have provided additional insights into the relationship between stress and smoking. To date, convergent data suggests that chronic cigarette smoking is associated with alterations in HPA and ANS functioning; however, less is known about the role of HPA and ANS functioning in smoking initiation and relapse following cessation. In order to organize existing findings and stimulate future research, the current paper summarizes the available literature on the roles of HPA axis and ANS functioning in the relationship between stress and cigarette smoking, highlights limitations within the existing literature, and suggests directions for future research to address unanswered questions in the extant literature on the biological mechanisms underlying the relationship between stress and smoking.
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Affiliation(s)
- Jessica M Richards
- Department of Psychology, Center for Addictions, Personality, and Emotion Research (CAPER), University of Maryland, 2103 Cole Activities Building, College Park, MD 20742, USA.
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El-Mas MM, El-Gowilly SM, Fouda MA, Saad EI. Role of adenosine A2A receptor signaling in the nicotine-evoked attenuation of reflex cardiac sympathetic control. Toxicol Appl Pharmacol 2011; 254:229-37. [PMID: 21550361 DOI: 10.1016/j.taap.2011.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 04/18/2011] [Accepted: 04/21/2011] [Indexed: 12/27/2022]
Abstract
Baroreflex dysfunction contributes to increased cardiovascular risk in cigarette smokers. Given the importance of adenosinergic pathways in baroreflex control, the hypothesis was tested that defective central adenosinergic modulation of cardiac autonomic activity mediates the nicotine-baroreflex interaction. Baroreflex curves relating changes in heart rate (HR) to increases or decreases in blood pressure (BP) evoked by i.v. doses (1-16μg/kg) of phenylephrine (PE) and sodium nitroprusside (SNP), respectively, were constructed in conscious rats; slopes of the curves were taken as measures of baroreflex sensitivity (BRS). Nicotine (25 and 100μg/kg i.v.) dose-dependently reduced BRS(SNP) in contrast to no effect on BRS(PE). BRS(SNP) was also attenuated after intracisternal (i.c.) administration of nicotine. Similar reductions in BRS(SNP) were observed in rats pretreated with atropine or propranolol. The combined treatment with nicotine and atropine produced additive inhibitory effects on BRS, an effect that was not demonstrated upon concurrent exposure to nicotine and propranolol. BRS(SNP) was reduced in preparations treated with i.c. 8-phenyltheophylline (8-PT, nonselective adenosine receptor antagonist), 8-(3-Chlorostyryl) caffeine (CSC, A(2A) antagonist), or VUF5574 (A(3) antagonist). In contrast, BRS(SNP) was preserved after blockade of A(1) (DPCPX) or A(2B) (alloxazine) receptors or inhibition of adenosine uptake by dipyridamole. CSC or 8-PT abrogated the BRS(SNP) depressant effect of nicotine whereas other adenosinergic antagonists were without effect. Together, nicotine preferentially impairs reflex tachycardia via disruption of adenosine A(2A) receptor-mediated facilitation of reflex cardiac sympathoexcitation. Clinically, the attenuation by nicotine of compensatory sympathoexcitation may be detrimental in conditions such as hypothalamic defense response, posture changes, and ventricular rhythms.
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Affiliation(s)
- Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
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Farha KA, AbouFarha R, Bolt M. The Acute Impact of Smoking One Cigarette on Cardiac Hemodynamic Parameters. Cardiol Res 2011; 2:58-65. [PMID: 28348663 PMCID: PMC5358189 DOI: 10.4021/cr24e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2011] [Indexed: 01/04/2023] Open
Abstract
Background The acute impact of tobacco smoking on the cardiac hemodynamic parameters and its pathological implication in the process of arterial atherosclerosis need further exploration. This investigation was purposed to assess the acute impact of tobacco smoke on blood pressure and cardiac hemodynamic parameters. Methods Using an Ultrasonic Cardiac Output Monitor, and DINAMAP Pro 400 Series V2 blood pressure monitor, several cardiac hemodynamic parameters and the blood pressure were assessed in 14 smokers, 11 females and 3 males, at 2 time points, before and after smoking of one cigarette. Data, in terms of ratio of the means and 95% confidence interval were analyzed using ANOVA. Results Single-subject design in which the subject has served as his/her own control has been used. Tobacco smoking led to statistically significant acute increase in the means of all hemodynamic parameters, except for heart rate in female subjects, as compared to the means obtained before smoking. Conclusions Cigarette smoking induces acute non-physiologic alteration in cardiac outflow forces, exposing the aortic valve and arch to mechanical injury that might be implicated in initiating and promoting the process of aortic arch atherosclerosis and associated pathological lesions.
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Affiliation(s)
- Khalid Abou Farha
- PRA-International, Institute for Clinical Pharmacology, Groningen, Netherlands
| | | | - Marc Bolt
- PRA-International, Institute for Clinical Pharmacology, Groningen, Netherlands
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Guan J, Mao C, Xu F, Zhu L, Liu Y, Geng C, Zhang L, Xu Z. Low doses of nicotine-induced fetal cardiovascular responses, hypoxia, and brain cellular activation in ovine fetuses. Neurotoxicology 2010; 30:290-7. [PMID: 19459226 DOI: 10.1016/j.neuro.2008.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Prenatal exposure to nicotine is associated with a variety of adverse outcomes. The present study investigated the effect of low doses of nicotine during pregnancy on fetal blood gases, cardiovascular system, and cellular activation in the brain. Intravenous administration of nicotine 10 or 25 microg/kg into ewe did not affect maternal blood gases, blood pressure, and heart rate. Maternal administration of nicotine also had no effect on fetal blood electrolyte concentrations, osmolality levels, and lactic acid levels. However, it significantly reduced fetal blood pO2 levels and oxygen saturation, increased fetal arterial blood pressure and decreased heart rate in utero. In addition, exposure to low doses of nicotine increased the expression of Fos in the paraventricular nucleus (PVN) and subfornic organ (SFO) in the fetal brain. The data demonstrated that even low doses of nicotine could impact significantly on fetal cardiovascular and central nervous systems, as well as oxygen status, and suggested a toxic risk to fetuses of exposure to low levels nicotine or second-hand smoking during pregnancy.
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Affiliation(s)
- Junchang Guan
- Perinatal Biology Center, Soochow University School of Medicine, Suzhou, China
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Cohen DL, Townsend RR. Does cigarette use modify blood pressure measurement or the effectiveness of blood pressure medications? J Clin Hypertens (Greenwich) 2010; 11:657-8. [PMID: 19878378 DOI: 10.1111/j.1751-7176.2009.00180.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Debbie L Cohen
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, 19104, USA.
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Effects of smoking cessation and weight gain on cardiovascular disease risk factors in Asian male population. Atherosclerosis 2009; 208:275-9. [PMID: 19660751 DOI: 10.1016/j.atherosclerosis.2009.07.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 06/17/2009] [Accepted: 07/05/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Smoking cessation leads to both beneficial and harmful changes in cardiovascular disease (CVD) risk factors. The basis of the harmful changes, however, is unknown. Our objective was to determine whether they are associated with the weight gain that accompanies smoking cessation. METHODS Study subjects were male cigarette smokers aged at least 30 years who visited the Health Promotion Center of Seoul National University Hospital between 1995 and 2007 repeatedly with a 1- to 3-year interval between first and second visit. Self-reporting questionnaires gathered clinical and socio-economic characteristics on the initial visit, and CVD risk factors (blood pressure, fasting blood glucose, and serum lipid profile) were measured on both the visits. RESULTS We compared the CVD risk factors between smoking quitters and smoking continuers. The quitters were more likely than the continuers to have harmful health changes such as increase in body weight (P<0.01), in systolic blood pressure, and in serum levels of total cholesterol, LDL-cholesterol, and non-HDL cholesterol (P<0.05). When stratified by body weight change, quitters who had gained more than the median (1.3 kg) were more likely than those who had not to have increase in blood pressure (P<0.01) and in serum levels of total cholesterol, triglycerides, non-HDL cholesterol, and fasting glucose (P<0.05). CONCLUSIONS Harmful changes in CVD risk factors associated with smoking cessation were mainly secondary to weight gain. To reduce the risk of cardiovascular disease in quitters, therefore, more attention should be focused on preventing weight gain.
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Making hypertensive smokers motivated in quitting: developing 'blood pressure equivalence of smoking'. J Hypertens 2008; 26:672-7. [PMID: 18327075 DOI: 10.1097/hjh.0b013e3282f430c1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To express the increased risk from smoking in terms of 'blood pressure' so that hypertensive smokers are motivated into quitting. METHODS Mortality risks of smokers were compared with nonsmokers in a large worker cohort in Taiwan (n = 23755 with a 17-year follow-up) for all-cause and for cardiovascular diseases. The blood pressure equivalence of smoking was then identified by the difference in mortality risks between smokers and nonsmokers. RESULTS Some interaction between hypertension and smoking was found to be synergistic. When hypertension and smoking co-existed, the all-cause mortality outcome [relative risk (RR) = 4.25] was larger than the sum or product of each individual risk for hypertension (RR = 2.16) or for smoking (RR = 1.97). The excess mortality risks of smoking for smokers were converted into a 'blood pressure equivalence'. The results demonstrate that the addition of smoking was similar to an increase of mortality risk approximately equivalent to an increase in blood pressure of 40 mmHg. CONCLUSIONS Smoking cessation in hypertensive patients could provide a reduction of mortality risks similar to a permanent reduction of 40 mmHg in blood pressure, over and above any antihypertensive medications. Appreciating this relationship enables physicians to bridge the clinical disconnection and motivates hypertensive smokers to seek smoking cessation. The use of a 'blood pressure equivalence of smoking' can link the two separate risk factors and may lead to a paradigm shift in overcoming an existing clinical challenge.
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Affiliation(s)
- Martin Hausberg
- From the Department of Internal Medicine D (M.H.), University of Muenster Hospitals and Clinics, Muenster, Germany; and the Division of Cardiovascular Diseases (V.K.S.), Department of Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Virend K. Somers
- From the Department of Internal Medicine D (M.H.), University of Muenster Hospitals and Clinics, Muenster, Germany; and the Division of Cardiovascular Diseases (V.K.S.), Department of Internal Medicine, Mayo Clinic, Rochester, Minn
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Adamopoulos D, van de Borne P, Argacha JF. New insights into the sympathetic, endothelial and coronary effects of nicotine. Clin Exp Pharmacol Physiol 2008; 35:458-63. [PMID: 18307741 DOI: 10.1111/j.1440-1681.2008.04896.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
1. Nicotine is a well studied pleiotropic agent which occurs naturally in tobacco smoke and has been largely accused for many of the adverse effects of smoking on the cardiovascular system, including autonomic imbalance, endothelial dysfunction and coronary blood flow dysregulation. 2. The acute sympathoexcitatory effects of smoking on the cardiovascular system are partially mediated by catecholamine release, muscle sympathetic nerve excitation and peripheral chemoreceptor sensitivity increase, consecutive to nicotinic receptor stimulation in the autonomic nervous system. 3. Recent animal data suggest that nicotine promotes the oxidative and inflammatory stress to the endothelium and induces pathological angiogenesis, leading to the progression of the atherosclerotic lesions. 4. Nicotine increases myocardial work without impairing the physiological coronary vasodilatation. Consequently, nicotine per se cannot explain the sudden reduction in coronary flow reserve after exposure to both active and passive smoking. 5. Nicotine's biological effects are characterized by a rapid onset of tolerance, which can explain why nicotine administration does not elicit acute coronary and chemoreflex side-effect in smokers.
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The effects of nicotine on the attentional modification of the acoustic startle response in nonsmokers. Psychopharmacology (Berl) 2008; 198:93-101. [PMID: 18338158 PMCID: PMC2650080 DOI: 10.1007/s00213-008-1094-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVE Research on nicotine and attention has mainly utilized samples of deprived smokers and tasks requiring volitional responses, raising the question of whether nicotine improves attention or simply alleviates withdrawal or improves motor speed. This study used the startle eyeblink reflex to assess nicotine effects on auditory attention in nonsmokers. MATERIALS AND METHODS Sixty-seven healthy young adult nonsmokers completed a tone discrimination task. Acoustic startle probes were presented 60, 120, 240, or 4,500 ms after the onset of two-thirds of the tones and during intertrial intervals. Attention was assessed via (1) short-lead prepulse inhibition (PPI) of startle, a measure of early filtering; (2) long-lead prepulse facilitation (PPF) of startle, a measure of sustained processing; and (3) the modification of PPI and PPF by focused attention. Participants completed two laboratory sessions, once while wearing a 7-mg transdermal nicotine patch and once while wearing a placebo patch. Patches were administered in a double-blind procedure. RESULTS Nicotine increased overall PPI, eta2(p)=0.09. Attention increased long-lead PPF, eta2(p)=0.25, but not short-lead PPI. Nicotine did not reliably enhance early or late controlled attentional processing in the sample overall. However, correlational analyses demonstrated that nicotine most improved attentional modification of short-lead PPI among participants with the weakest early attentional processing under placebo conditions. CONCLUSIONS Nicotine enhanced early attentional filtering in general, and the effects of nicotine on early focused attention were dependent upon individual differences in placebo levels of attentional processing. The present data suggest that the effects of nicotine on attention extend beyond the alleviation of withdrawal and simple motor speeding.
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