吸烟与心血管疾病概括.pptVIP

* Key Point Flow-dependent dilation was significantly blunted in current smokers compared with nonsmokers. Zeiher et al evaluated whether long-term smoking is associated with impaired endothelial vasodilator function, irrespective of preexisting atherosclerotic disease. Blood vessels were distinguished as either normal or irregular, according to their angiographic appearance. Ninety-six long-term current smokers (at least 2 pack/years of cigarette smoking immediately before the study) underwent diagnostic cardiac catheterization. Patients were excluded from the study if they had evidence of 30% stenosis in the left anterior descending (LAD) coronary artery or a history of variant angina, valvular heart disease, clinical evidence of heart failure, or diabetes. Intracoronary ultrasound examination was performed in 24 patients. LAD diameter was evaluated angiographically before and after a 7-mg papaverine infusion. Papaverine maximally increases coronary blood flow without affecting global hemo-dynamics. Changes in LAD diameter were utilized to assess flow-dependent dilation. Flow-dependent dilation was significantly blunted in current smokers compared with nonsmokers (P.0001). When vessel segments were divided into normal and irregular segments based upon their angiographic appearance, both smoking groups demonstrated significantly blunted response in flow-dependent vasodilation compared with the nonsmoking groups (P.01). The authors concluded that long-term cigarette smoking is associated with a reduction in endothelium-dependent vasodilation, regardless of the presence or absence of coronary atherosclerotic lesions. Reference Zeiher AM, Sch?chinger V, Minners J. Long-term cigarette smoking impairs endothelium-dependent coronary arterial vasodilator function. Circulation. 1995;92:1094-1100. * Key Point Current smokers, without evidence of significant coronary artery disease (CAD), are more likely to have epicardial endothelial dysfunction than nonsmokers. In an