Kool M J, Hoeks A P, Struijker Boudier H A, Reneman R S, Van Bortel L M
Department of Pharmacology, University of Limburg, Maastricht, The Netherlands.
J Am Coll Cardiol. 1993 Dec;22(7):1881-6. doi: 10.1016/0735-1097(93)90773-t.
This study investigated the short-term effects of smoking on hemodynamic function and distensibility and compliance of large arteries in habitual smokers. In addition, the effect of smoking was not measured in nonsmokers, but vessel wall properties were compared between smokers and nonsmokers (basal state).
Smoking is a well known risk factor for atherosclerosis. Loss of distensibility and compliance of large arteries may play a role in the onset of atherosclerosis.
The distensibility and compliance coefficients of the common carotid and brachial arteries were determined from the arterial wall displacement during systole and the end-diastolic diameter by using a vessel wall movement detector and from the pulse pressure as assessed in the upper arm. Cardiac function (cardiac output, stroke volume) was measured with Doppler echocardiography. Systemic vascular resistance was calculated as mean arterial pressure divided by cardiac output.
In habitual smokers, smoking one cigarette caused a sharp increase in blood pressure (6%) and heart rate (14%). Cardiac index increased (16%), mainly because of the marked increase in heart rate. Stroke and systemic vascular resistance indexes did not change significantly. Smoking enhanced forearm blood flow after wrist occlusion (17%), but total forearm blood flow was unchanged, suggesting an increase in muscle blood flow and a decrease in skin flow. Because of higher blood pressure, the diameter of the elastic common carotid artery increased by 3% (passive phenomenon). Distensibility of the carotid artery decreased (7%), and as a result, carotid compliance was preserved. In contrast, despite higher blood pressure, the diameter of the muscular brachial artery did not change, suggesting an increased vascular tone. Brachial distensibility and compliance decreased (18% and 19%, respectively). Habitual smokers were comparable to nonsmokers with regard to blood pressure, cardiac function, vascular resistance and vessel wall properties of large arteries. Heart rate was higher in habitual smokers (14%).
These data indicate that in habitual smokers, smoking one cigarette causes short-term increases in arterial wall stiffness that might be harmful to the artery and increase the risk for plaque rupture. Except for a higher heart rate, no obvious long-term effect of smoking was observed on hemodynamic variables and arterial stiffness. Because acute cardiovascular events are mainly due to plaque rupture, the short-term effects of smoking might be a more important risk than long-term effects for these acute ischemic events.
本研究调查了吸烟对习惯性吸烟者血液动力学功能以及大动脉扩张性和顺应性的短期影响。此外，未对非吸烟者进行吸烟影响的测量，但比较了吸烟者与非吸烟者（基础状态）的血管壁特性。
吸烟是动脉粥样硬化的一个众所周知的危险因素。大动脉扩张性和顺应性的丧失可能在动脉粥样硬化的发病中起作用。
使用血管壁运动探测器根据收缩期动脉壁位移和舒张末期直径，以及通过评估上臂的脉压来测定颈总动脉和肱动脉的扩张系数和顺应系数。用多普勒超声心动图测量心功能（心输出量、每搏输出量）。全身血管阻力计算为平均动脉压除以心输出量。
在习惯性吸烟者中，吸一支烟导致血压急剧升高（6%）和心率增加（14%）。心脏指数增加（16%），主要是由于心率显著增加。每搏输出量和全身血管阻力指数无明显变化。吸烟使手腕阻断后前臂血流量增加（17%），但前臂总血流量未改变，提示肌肉血流量增加而皮肤血流量减少。由于血压升高，弹性颈总动脉直径增加3%（被动现象）。颈动脉扩张性降低（7%），结果颈动脉顺应性得以保留。相比之下，尽管血压升高，肌性肱动脉直径未改变，提示血管张力增加。肱动脉扩张性和顺应性降低（分别为18%和19%）。习惯性吸烟者在血压、心功能、血管阻力和大动脉血管壁特性方面与非吸烟者相当。习惯性吸烟者心率较高（14%）。
这些数据表明，在习惯性吸烟者中，吸一支烟会导致动脉壁僵硬度短期内增加，这可能对动脉有害并增加斑块破裂的风险。除心率较高外，未观察到吸烟对血液动力学变量和动脉僵硬度有明显的长期影响。由于急性心血管事件主要是由斑块破裂引起的，吸烟的短期影响可能比长期影响对这些急性缺血性事件来说是更重要的风险因素。
