Winniford M D
Department of Internal Medicine, University of Iowa, Iowa City 52242.
J Hypertens Suppl. 1990 Sep;8(5):S17-23.
Compared to non-smokers, chronic smokers are at increased risk of developing atherosclerotic vascular disease, myocardial infarction, unstable angina and sudden death. The acute systemic hemodynamic response to smoking includes an increase in the heart rate, arterial pressure, cardiac output and myocardial contractility. These acute effects are primarily mediated by activation of the sympathetic nervous system. In patients with heart disease, smoking may cause a deterioration in cardiac performance. In the coronary circulation, smoking induces coronary vasoconstriction which can be prevented by alpha-adrenergic blockade, nitrates and calcium channel blockers. Non-selective beta-adrenergic blockade potentiates both the systemic and coronary vasoconstrictor effect of smoking. Other adverse effects of smoking on the cardiovascular system include a reduction in high-density lipoprotein (HDL) cholesterol, an increase in platelet reactivity and an increase in fibrinogen concentrations. These effects on systemic and coronary hemodynamics, lipid metabolism and hemostasis may contribute to the long-term adverse consequences of smoking.
与不吸烟者相比，长期吸烟者患动脉粥样硬化性血管疾病、心肌梗死、不稳定型心绞痛和猝死的风险增加。吸烟对全身急性血流动力学的影响包括心率加快、动脉压升高、心输出量增加和心肌收缩力增强。这些急性效应主要由交感神经系统激活介导。在患有心脏病的患者中，吸烟可能导致心脏功能恶化。在冠状动脉循环中，吸烟会诱发冠状动脉收缩，α-肾上腺素能阻滞剂、硝酸盐和钙通道阻滞剂可预防这种收缩。非选择性β-肾上腺素能阻滞剂会增强吸烟对全身和冠状动脉的血管收缩作用。吸烟对心血管系统的其他不利影响包括高密度脂蛋白（HDL）胆固醇降低、血小板反应性增加和纤维蛋白原浓度升高。这些对全身和冠状动脉血流动力学、脂质代谢和止血的影响可能导致吸烟的长期不良后果。
