Hahad Omar, Arnold Natalie, Prochaska Jürgen H, Panova-Noeva Marina, Schulz Andreas, Lackner Karl J, Pfeiffer Norbert, Schmidtmann Irene, Michal Matthias, Beutel Manfred, Wild Philipp S, Keaney John F, Daiber Andreas, Münzel Thomas
Department of Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
Front Cardiovasc Med. 2021 May 19;8:674622. doi: 10.3389/fcvm.2021.674622. eCollection 2021.
Cigarette smoking is one of the most complex and least understood cardiovascular risk factors. Importantly, differences in the tobacco-related pathophysiology of endothelial dysfunction, an early event in atherogenesis, between circulatory beds remain elusive. Therefore, this study evaluated how smoking impacts endothelial function of conduit and resistance arteries in a large population-based cohort. 15,010 participants (aged 35-74 years) of the Gutenberg Health Study were examined at baseline from 2007 to 2012. Smoking status, pack-years of smoking, and years since quitting smoking were assessed by a computer-assisted interview. Endothelial function of conduit and resistance arteries was determined by flow-mediated dilation (FMD) of the brachial artery, reactive hyperemia index (RHI) using peripheral arterial tonometry, as well as by reflection index (RI) derived from digital photoplethysmography, respectively. Among all subjects, 45.8% had never smoked, 34.7% were former smokers, and 19.4% were current smokers. Mean cumulative smoking exposure was 22.1 ± 18.1 pack-years in current smokers and mean years since quitting was 18.9 ± 12.7 in former smokers. In multivariable linear regression models adjusted for typical confounders, smoking status, pack-years of smoking, and years since quitting smoking were independently associated with RHI and RI, while no association was found for FMD. Overall, no clear dose-dependent associations were observed between variables, whereby higher exposure tended to be associated with pronounced resistance artery endothelial dysfunction. Cigarette smoking is associated with altered endothelial function of resistance, but not conduit arteries. The present results suggest that smoking-induced endothelial dysfunction in different circulatory beds may exhibit a differential picture.
吸烟是最复杂且最不为人所理解的心血管危险因素之一。重要的是，循环系统各部位之间在动脉粥样硬化早期事件即内皮功能障碍的烟草相关病理生理学方面的差异仍不明确。因此，本研究评估了吸烟对一个大型人群队列中传导动脉和阻力动脉内皮功能的影响。2007年至2012年，对古登堡健康研究的15010名参与者（年龄在35 - 74岁之间）进行了基线检查。通过计算机辅助访谈评估吸烟状况、吸烟包年数和戒烟年限。分别通过肱动脉的血流介导的血管舒张（FMD）、使用外周动脉张力测定法的反应性充血指数（RHI）以及从数字光电容积描记法得出的反射指数（RI）来测定传导动脉和阻力动脉的内皮功能。在所有受试者中，45.8%从未吸烟，34.7%为既往吸烟者，19.4%为当前吸烟者。当前吸烟者的平均累积吸烟暴露量为22.1±18.1包年，既往吸烟者的平均戒烟年限为18.9±12.7年。在针对典型混杂因素进行调整的多变量线性回归模型中，吸烟状况、吸烟包年数和戒烟年限与RHI和RI独立相关，而未发现与FMD有关联。总体而言，各变量之间未观察到明确的剂量依赖性关联，较高的暴露量往往与明显的阻力动脉内皮功能障碍相关。吸烟与阻力动脉而非传导动脉的内皮功能改变有关。目前的结果表明，吸烟诱导的不同循环系统部位的内皮功能障碍可能呈现出不同的情况。
