Association between smoking status and the parameters of vascular structure and function in adults: results from the EVIDENT study

Association of Smoking with Indicators of the Structure and Function of Blood Vessels in Middle-aged Men

Aim. To study the association of smoking with indicators of the structure and function of blood vessels in a sample of middle-aged men.Material and methods. This study is part of a 32-year prospective cohort observation of males starting in childhood (11-12 years). The study included 301 (30.0%) representatives of the original population sample aged 41-44 years. The examination included a survey on a standard questionnaire with an assessment of the status and intensity of smoking, of anthropometric indicators, blood pressure (BP), and determination of the blood lipid spectrum. The stiffness of the arterial wall and central pressure were measured by the method of applanation tonometry. The carotid intima-media thickness of the common carotid artery (C-IMT) was estimated by the method of ultrasonic duplex scanning of the main vessels of the neck.Results. Of the 301 men examined, aged 41-44 years, 92 (30.6%) people never smoked, 73 (24.3%) smoked in the past and 136 (45.2%) people currently smoke. Former smokers were divided by the intensity of smoking in the past as follows: less than 20 cigarettes/day were smoked by 41 (56.0%) people, and ≥20 cigarettes/day - 32 (44.0%) people. Among current smokers, less than 20 cigarettes/day were smoked by 63 (46.0%) people, and ≥20 cigarettes - 73 (54.0%) people. Current smokers have a statistically significantly higher level of triglycerides and lower cholesterol of high density lipoproteins in the blood, augmentation index (AIx), augmentation blood pressure and C-IMT thicker than non-smokers. The thickness of the C-IMT and AIx was statistically significantly greater among current smokers who smoked 20 or more cigarettes daily. Men who smoked in the past had significantly greater body weight, waist circumference and pulse wave velocity. 12.4% of AIx variability was attributable to current smoking combined with variability in alcohol consumption, blood glucose, and heart rate. The body mass index (BMI) and ethanol consumption are independent determinants of peripheral and central systolic pressure, and account for 17.8% and 18.6% of their variance, respectively. The combined contribution of current smoking, age, BMI, low-density lipoprotein cholesterol and plasma glucose to the thickness variability of C-IMT was 13.7%. Among men with a smoking duration in the past >10 years, the levels of total cholesterol, triglycerides and arterial stiffness indicators - AIx, pulse pressure amplification were higher compared to peers with a shorter smoking duration.Conclusion. Current smoking is associated with atherogenic changes in the blood lipid spectrum, impaired structure and function of the main arteries. Moreover, the severity of structural and functional disorders of the arteries is associated with the intensity of current smoking. If you give up smoking, there is a potential possibility of reversibility of these vascular disorders.

Effects of combined healthy lifestyle factors on functional vascular aging: the Rotterdam Study

OBJECTIVE

To evaluate whether components of a healthy lifestyle, combined and individually, are associated with arterial stiffness as a marker of functional vascular aging.

METHODS

We included 3235 participants aged 61-96 years from the Rotterdam Study. Measures of arterial stiffness included: aortic pulse wave velocity and carotid distensibility coefficient. Participants were scored one point for each of healthy lifestyle factors: consumption of five or more of fruits and/or vegetables per day, 75 min or more vigorous physical activity per week, 18.5 ≤ BMI ≤ 24. 9, never smoked and light-to-moderate alcohol intake (maximum seven glasses for women and 14 glasses for men) per week. Also a combined score (0-5) was computed by adding the five factors. Linear regression analysis was used to evaluate the association of healthy lifestyle and measures of arterial stiffness adjusting for confounders.

RESULTS

Participants had -0.113 [95% confidence interval (CI): -0.196, -0.029] difference in mean aortic pulse wave velocity m/s per unit increment of the lifestyle factors score, independent of cardiovascular risk factors. Higher fruit and vegetable consumption -0.221 (95% CI: -0.409, -0.034) and physical activity -0.239 (95% CI: -0.433, -0.044) were also significantly associated with reduced aortic pulse wave velocity. The corresponding estimates in carotid distensibility coefficient lacked statistical significance when we adjusted for cardiovascular risk factors.

CONCLUSION

Combining multiple healthy lifestyle factors is associated with reduced aortic stiffness, a measure of functional vascular aging and independent of cardiovascular risk factors.

Smoking Behaviors and Arterial Stiffness Measured by Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND

Though smoking is strongly associated with peripheral vascular disease and arteriosclerosis, smoking's association with arterial stiffness has been inconsistent and mostly limited to a single arterial segment. We examined the relationship between smoking behaviors with arterial stiffness in multiple arterial segments among community dwelling older adults.

METHODS

The cross-sectional relationship between smoking behavior with carotid-femoral (cfPWV) and femoral-ankle pulse wave velocity (faPWV) was examined in 5,002 men and women, separately, of the Atherosclerosis Risk in Communities (ARIC) cohort study. Brachial-ankle PWV was also assessed and presented in Supplementary Material. Heckman selection models were used to control for selective attrition and death in the ARIC cohort.

RESULTS

In women, faPWV was lower in current smokers compared to never smokers (-66.0cm/s; 95% confidence interval (95% CI): -94.6, -37.4), and was 1.0cm/s lower (95% CI: -1.8, -0.2) for every additional year a woman smoked, after adjustment for confounders. Among women, cfPWV was not associated with smoking status or cigarette pack-years. Additionally, no associations of smoking status and cigarette pack-years with PWV were observed among men. Years since smoking cessation was not associated with PWV in either gender.

CONCLUSION

Both smoking status and cumulative smoking exposure were associated with lower peripheral arterial stiffness among women, but not among men. We did not observe an association between central arterial stiffness and smoking status in either gender. The profound and well-documented adverse effects of cigarette smoking on the vasculature may not include a sustained stiffening of the arteries measured at older age.

Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study

Background

Affective temperaments (anxious, depressive, cyclothymic, irritable and hyperthymic) measure subclinical manifestations of major mood disorders. Furthermore, cumulating evidence suggests their involvement in somatic disorders as well. We aimed to assess associations between affective temperament scores and blood pressure and arterial stiffness parameters in hypertensive patients.

Methods

In this cross-sectional study, 173 patients with well-controlled or grade 1 chronic hypertension, with no history of depression, completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Scale (HAM-A) questionnaires in three GP practices. Arterial stiffness was measured with tonometry (PulsePen).

Results

According to multiple linear regression analysis, cyclothymic temperament score was positively associated with brachial systolic blood pressure independently of age, sex, total cholesterol, brachial diastolic blood pressure, BDI, HAM-A and the use of alprazolam (β = 0.529, p = 0.042), while hyperthymic temperament score was negatively related to augmentation index independent of age, sex, smoking, heart rate, BDI, HAM-A and the use of alprazolam (β = -0.612, p = 0.013). A significant interaction was found between cyclothymic temperament score and sex in predicting brachial systolic blood pressure (p = 0.025), between irritable and anxious temperament scores and sex in predicting pulse wave velocity (p = 0.021, p = 0.023, respectively) and an interaction with borderline significance between hyperthymic temperament score and sex in predicting augmentation index (p = 0.052).

Conclusions

The present findings highlight elevated blood pressure among subjects with high cyclothymic temperament as well as an increased level of arterial stiffening in subjects with low hyperthymic scores suggesting that affective temperaments may play a role in the development of hypertension and arterial stiffening and may thus represent markers of cardiovascular risk. Sex differences were also present in these associations.

Peripheral artery disease and exertional leg symptoms in diabetes patients in Ghana

Background

Peripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana.

Methods

In a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms.

Results

The overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 – 8.1), p < 0.05] and rest pain [4.3 (1.58 – 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 – 2.17), p < 0.05] was associated with PAD in all participants.

Conclusions

There is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-016-0247-x) contains supplementary material, which is available to authorized users.

Augmentation index is associated with coronary revascularization in patients with high Framingham risk scores: a hospital-based observational study

Background

This study analyzed PWAs in patients with high Framingham risk scores to determine whether PWA is predictive of coronary artery disease (CAD) severity and percutaneous coronary intervention (PCI) treatment.

Methods

In total, 310 patients were screened due to suspected CAD; 78 were excluded due to PCI history (32), atrial fibrillation (11), or acute myocardial infarction (35). The augmentation index (AIx) was analyzed immediately before coronary angiography. PCI was performed in 73 (31.5 %) patients.

Results

The mean AIx, adjusted by heart rate (AIx@75) was different for each clinical diagnosis in the PCI group (stable angina, 30.6 ± 7.7 %; silent ischemia, 30.2 ± 8.6 %; unstable angina, 38.5 ± 8.5 %; p = 0.026). The 10-year estimate of CVD risk, based on the Framingham heart score, was 25.3 ± 6.5 % and the mean AIx@75 was 31.6 ± 8.5 % in the PCI group, significantly higher than in the non-PCI group (18.8 ± 10.2 %, p < 0.001; 27.2 ± 9.0 %, p = 0.006, respectively). An inverse correlation was observed between the minimal luminal area and AIx@75 (rho = −0.559, p = 0.010, n = 20). In ROC curve analysis of multivariate logistic regression model, higher HDL, medication of hypertension, and higher body mass index were associated with non-PCI and higher AIx@75 was associated with PCI (area under the curve, 0.764; 95 % CI: 0.701 to 0.819, z = 8.005; p <0.001).

Conclusions

The AIx@75 seemed to reflect the clinical severity of CAD and was associated with PCI in patients with a high Framingham risk score.

Clustering of lifestyle characteristics and their association with cardio-metabolic health: the Lifestyles and Endothelial Dysfunction (EVIDENT) study

Little is known about the clustering patterns of lifestyle behaviours in adult populations. We explored clusters in multiple lifestyle behaviours including physical activity (PA), smoking, alcohol use and eating habits in a sample of adult population. A cross-sectional and multi-centre study was performed with six participating groups distributed throughout Spain. Participants (n 1327) were part of the Lifestyles and Endothelial Dysfunction (EVIDENT) study and were aged between 20 and 80 years. The lifestyle and cardiovascular risk (CVR) factors were analysed using a clustering method based on the HJ-biplot coordinates to understand the variables underlying these groupings. The following three clusters were identified. Cluster 1: unhealthy, 677 subjects (51 %), with a slight majority of men (58·7 %), who were more sedentary and smokers with higher consumption of whole-fat dairy products, bigger waist circumference as well as higher TAG levels, systolic blood pressure (SBP) and CVR. Cluster 2: healthy/PA, 265 subjects (20 %), including 24·0 % of males with high PA. Cluster 3: healthy/diet, including 29 % of the participants, with a higher consumption of olive oil, fish, fruits, nuts, vegetables and lower alcohol consumption. Using the unhealthy cluster as a reference, and after adjusting for age and sex, the multiple regression analysis showed that belonging to the healthy/PA cluster was associated with a lower waist circumference, body fat percentage, SBP and CVR. In summary, the three clusters were identified according to lifestyles. The ‘unhealthy’ cluster had the least favourable clinical parameters, the ‘healthy/PA’ cluster had good HDL-cholesterol levels and low SBP and the ‘healthy/diet’ cluster had lower LDL-cholesterol levels and clinical blood pressure.