The midterm differential effects of heat-not-burn and conventional cigarettes on coronary flow, vascular function and oxidative stress are independent of nicotine levels

Introduction

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product linked to reduced exposure to carbon monoxide (CO).

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig) on endothelial and coronary function as well as on nicotine levels, oxidative stress and platelet activation after 1 month of switching to HNBC.

We examined 75 smokers. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month.

At baseline and at 1 month, we assessed a) coronary flow reserve (CFR) by echocardiography b) flow-mediated dilation (FMD) c) Cotinine blood levels, a stable metabolite of nicotine d) malondialdehyde (MDA), a marker of oxidative stress and thromboxane B2 (TXB2), a marker of platelet activation e) the exhaled CO and the number of cigarettes and/or heat stick of HNBC used. Fagerstrom score, a marker of dependence from smoking habit was also calculated.

Results

Compared to Tcig smoking, switching to HNBC for 1-month improved CO (difference in CO between groups: 10.42 ppm; 95% CI 3.07 to 17.76, p=0.007), FMD (difference in FMD=4.3%; 95% CI: 1.23 to 7.51, p=0.009; and CFR (difference in CFR =0.98; 95% CI: 0.23 to 1.80, p=0.02). MDA and TXB2 concentration significantly decreased in subjects switching to HNBC compared to tobacco smokers (difference MDA=0.38 nmol/L; 95% CI 0.10 to 0.66, p=0.009, 45pg/mL; 95% CI 5.28 to 86.31, p=0.03). None of the aforementioned parameters changed in the control group at 1 month compared to baseline (p>0.05).

Cotinine blood levels were similar between the TC cig and HNBC group both at baseline and after one month of use (p>0.05). However, cotinine blood levels at baseline and 1 month correlated with the number cigarettes used at baseline (r=0.45 p=0.04) or the number of heat sticks used at one month (r=0.50, p=0.03) respectively, Baseline Fagerstrom score was also associated with number of heat sticks used at 1 month (r=0.48, p=0.04) and cotinine levels at baseline and at 1 month (p=0.50, p=0.03 and r=0.57, p=0.01 respectively).

Conclusions

HNBCs exert a less detrimental effect on vascular function platelet activation and oxidative stress than tobacco smoking that is independent of nicotine levels and is linked with the parallel reduction the exhaled of CO.

Funding Acknowledgement

Type of funding sources: None.

Effects of heat-not-burn compared to combustible cigarettes on coronary flow, myocardial work index and vascular function

Funding Acknowledgements

Type of funding sources: None.

Aim/Introduction:

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Purpose

We compare the effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress.

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomized into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by Doppler echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results

Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p < 0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: -55% vs -2.4%), FMD ( +55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs -0.5%), GLS (+6% vs +1%), GWW (-19% vs +0.5%), MDA (-19% vs 1 %), and TxB2 (-12% vs 4%) (p < 0.05 for all comparisons).

Conclusions

HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than combustible tobacco.

Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress

 

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomised into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results

Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p<0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: −55% vs −2.4%), FMD (+55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs −0.5%), GLS (+6% vs +1%), GWW (−19% vs +0.5%), MDA (−19% vs 1%), and TxB2 (−12% vs 4%) (p<0.05 for all comparisons).

Conclusions

HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than tobacco

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease

Effects of electronic cigarette on platelet and vascular function after one month of use

Background and aims

Smoking is a major factor that contributes to the development of cardiovascular disease. Smoking cessation delays progress of coronary artery disease. Electronic cigarette is proposed as a bridge to smoking cessation. We examined its effects on platelet function after 1 month of use compared to tobacco smoking.

Patients and methods

40 current smokers (mean age 48 years±5) without cardiovascular disease were randomized to smoke either a conventional cigarette (conv-cig) or an electronic cigarette (e-cig) (electronic cigarette fluid with nicotine concentration of 12 mg/dL) for one month. All subjects smoked an electronic cigarette with nicotine concentration 12 mg/dL for one month. Measurements were performed at baseline and after one month of smoking the conventional or electronic cigarette. We measured a) perfused boundary region (PBR) of the sublingual arterial micro vessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) platelet function by two different methods, namely the novel Platelet Function Analyzer PFA-100 and the traditional Light Transmission Aggregometry (LTA) d) the exhaled CO level (parts per million-ppm) as a smoking status marker; and e) the plasma malondialdehyde (MDA) levels, as an oxidative stress burden index.

Results

After 1 month of electronic smoking, we did not observe any significant change in platelet function and arterial stiffness (p>0.05 for all markers) with the exception of a reduction of MDA (1.22±0.1 vs 1.09±0.1 μmol/L, p=0.03) and exhaled CO; 14.9±0.7 vs 5.9±0.7 ppm, p<0.001. Conversely, after continuation of conventional cigarette smoking for a month, platelet function was further impaired as assessed by PFA [125,5±31,1 vs 152,35±51,4 U, p=0.047) and by LTA (epinephrine as stimulator) [59,8%±16,1 vs 35,6%±19.1, p<0.001] and markers of arterial stiffness were deteriorated, as assessed by PWV (9,5±2,8 vs 10,3±2,9, p=0,028) and by Aixc (8,36±35,9 vs 30,4±21,6, p=0,004).

Conclusions

Electronic Cigarette smoking has a neutral effect on platelet function and arterial stiffness markers compared to conventional tobacco smoking which further deteriorates platelet and vascular function during one moth of use.

Funding Acknowledgement

Type of funding source: None

P940Effects of IQOS smoking on vascular function, coronary flow reserve, myocardial deformation and myocardial work index during one month of use

Background

IQOS smoking (heat-no burn smoke product) is proposed to reduce harm compared to conventional smoking. We examined its effects on vascular function, myocardial deformation and ventricular arterial coupling.

Methods

Thirty-seven current smokers (mean age 48±5 years, >20 cigarettes /day) without cardiovascular disease and 20 healthy subjects with similar age sex and risk factors participated in the study. All subjects were instructed to smoke only IQOS for one month. Measurements were performed at baseline and 1 month after smoking IQOS. we measured a) the aortic PWV (PWV) and central aortic systole blood pressure (SBPc) by Complior; b) the exhaled CO level (parts per million-ppm) as a smoking status marker; and c) brachial systolic (SBP)and diastolic (DBP) blood pressure and heart rate (HR) a) flow mediated dilation (FMD) of the brachial artery b) coronary flow reserve (CFR) after adenosine infusion by Doppler echocardiography and c) global longitundinal strain (GLS) peak twisting and untwisting velocity and myocardial work index derived by pressure –myocardial strain loops by speckle tracking imaging PWV to GLS ratio was also used as a marker of ventricular arterial coupling

Results

At baseline exhaled CO, PWV, SBPc, FMD, PWV/GLS ratio, myocardial work index and peak untwisting velocity were higher and CFR was lower in smokers compared to controls (14.9±7 vs. 4.2±1 ppm, p<0.001, 8.7±1.4 vs 10.0±1.6 m/s, p<0.05; 118±16 vs 110±7 mmHg p<0.001, 6.9±2 vs 9.5±2% p<0.001, −0.61±0.21 vs. −0.45±0.11 m/sec%, p<0.001, 1926±284 vs 1826±300 mmHg% p=0.04, −122±36 vs −95±25 deg/sec, p=0.02, 2.5±0.9 vs. 3.1±0.8 p=0.001 respectively). In the chronic phase we observed a significant improvement of FMD, CFR, GLS, PWV/GLS, myocardial work index and peak untwisting velocity compared to baseline (12±2% vs. 6.9±2%, p=0.03; 3.2±0.6 vs. 2.5±0.9 p=0.001; −19.3±2.2% vs. −21.1±2.8%, p=0.001; −0.61±0.21 vs. −0.47±0.12 m/sec% p=0.03; 1926±284 vs 1830±343 mmHg% p=0.03, −122±36 vs −105±25 deg/sec, p=0.03, respectively) in parallel with reduction of the exhaled CO (14.9±7 vs. 6±4.9 ppm, p<0.001). HR remained unchanged throughout the study and there was a borderline reduction of central aortic systolic blood pressure (118±16 vs. 114±19 mmHg, p=0.048).

Conclusions

Replacement of conventional cigarettes with IQOS results in improved LV longitundinal myocardial deformation, LV untwisting and reduced LV myocardial work index possibly linked to the concomitant improvement of aortic elasticity, endothelial and coronary microcirculatory function and ventricular-arterial coupling within 1 month.

Determination of plasma cell secreting potential as an index of maturity of myelomatous cells and a strong prognostic factor

According to the widely accepted myeloma staging system, the bulk of paraprotein is the main determinant of disease stage. However, myelomatous plasma cells differ considerably in their ability to synthesize and secrete monoclonal paraprotein. We determined plasma cell secreting potential (PCSP) as the amount of M-component, divided by the percentage of marrow plasmacytic infiltration, in 240 patients with myeloma, and correlated our results with chain isotype, plasma cell morphology, severity of bone disease, well-recognized prognostic factors, such as serum LDH, CRP, albumin and beta2-microglobulin, treatment response and overall survival. PCSP was higher in IgG than in other myeloma types, and was an almost constant parameter for each individual patient, in 134/166 cases. A > 10% decrease of PCSP in 26 patients was associated with disease aggressiveness and treatment failure. Patients with MGUS had significantly higher PCSP than those with myeloma of the same chain type. Higher PCSP was associated with stage I, absence of Bence-Jones proteinuria and indolent forms of disease with lower proliferating cell nuclear antigen (PCNA) positivity, serum LDH, alpha2-globulins, CRP and beta2-microglobulin and higher albumin levels. Conversely, patients with immature/plasmablastic morphology and those with severe bone disease had lower PCSP. Good responders to treatment had significantly higher PCSP than moderate and poor responders and PCSP was strongly correlated with overall survival in IgG and IgA myeloma. In conclusion, PCSP reflects the maturation status of myelomatous cells and therefore can be used as a prognostic factor, since patients with high secreting potential represent a lower malignancy group, in comparison to those with a low secreting potential.