Increased carotid plaque burden in men with the fibrillin‐1 2/3 genotype

Fibrillin‐1 (FBN1) is an important constituent of the vascular wall and earlier studies have indicated an effect of the FBN1 2/3 genotype on blood pressure as well as aortic stiffness in men. The aim of the present study was to determine whether the FBN1 2/3 genotype was associated with the presence of carotid plaque and incident cardiovascular morbidity and mortality in middle‐aged subjects. The FBN1 genotype was characterized in 5765 subjects (2424 men, 3341 women; age 45–69 years) recruited from the Malmö Diet and Cancer Study Cardiovascular Cohort, Sweden. Plaque occurrence and intima–media thickness (IMT) of the carotid artery were assessed by ultrasound. The incidence of first cardiovascular events (myocardial infarction and stroke) and cause‐specific mortality were monitored over a mean follow‐up period of 13.2 years. The most common FBN1 genotypes were 2/2, 2/3 and 2/4, which accounted for 92.2% (n = 5317) of subjects. There were no differences between the three genotypes regarding age, blood pressure, glucose, lipids, smoking habits, common carotid artery diameter and intima–media thickness in men and women. The presence of plaque in the carotid artery was higher in men with the 2/3 genotype compared with the 2/2 and 2/4 genotypes (55% vs 46% and 50%, respectively; P = 0.007). No similar differences were observed in women. No significant relationship was observed between FBN1 genotypes and the incidence of cardiovascular disease or all‐cause mortality. The increased prevalence of plaque in the carotid artery of middle‐aged men with the FBN1 2/3 genotype indicates pathological arterial wall remodelling with a more pronounced atherosclerotic burden.     

Associations of glycated haemoglobin A1c and glycated albumin with subclinical atherosclerosis in middle‐aged and elderly Chinese population with impaired glucose regulation

The aim of this study was to investigate the correlations of glycated haemoglobin A1c (HbA1c) and glycated albumin (GA) with subclinical atherosclerosis in middle‐aged and elderly Chinese populations with impaired glucose regulation (IGR). In total, 640 subjects with IGR and no history of cardiovascular disease or carotid artery plaque were recruited for this study (256 men, 384 women; age range, 40–70 years). The carotid intima‐media thickness (C‐IMT) measured by carotid ultrasonography was used as an indicator of subclinical atherosclerosis. Increased C‐IMT was defined as ≥ 0.70 mm (upper quartile). HbA1c and GA were measured with high‐performance liquid chromatography and enzymatic method, respectively. The average HbA1c and GA among all 640 subjects were 5.7 ± 0.3% and 14.0 ± 1.1%, respectively. HbA1c and GA were higher in subjects with increased C‐IMT than in subjects with normal C‐IMT (5.8 ± 0.3% vs 5.7 ± 0.3% and 14.2 ± 1.0% vs 13.9 ± 1.1%, respectively; both P < 0.01). Correlation analysis showed that both HbA1c and GA were positively correlated with C‐IMT (r = 0.135 and 0.112, respectively; both P < 0.01). Logistic regression analysis revealed that both HbA1c (odds ratio (OR), 2.630; 95% confidence interval (95% CI), 1.401–4.935; P = 0.003) and GA OR, 1.215; 95% CI, 1.008–1.466; P = 0.041) were independent risk factors for increased C‐IMT. Both HbA1c and GA reflect the risk of subclinical atherosclerosis in middle‐aged and elderly Chinese populations with IGR.     

Additional role of serum 25‐hydroxyvitamin D3 levels in atherosclerosis in Chinese middle‐aged and elderly men

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Association of serum osteocalcin levels with major adverse cardiovascular events: A 4.4‐year retrospective cohort study

We investigated whether the serum osteocalcin levels at baseline were associated with the incidence of major adverse cardiovascular events (MACE) in a population‐based retrospective cohort study of Chinese subjects. Coronary angiography was used to diagnose coronary artery disease (CAD). Survival curves were analyzed by performing log‐rank tests with Kaplan‐Meier figures. Multivariable Cox proportional hazards regression was performed to identify the association of serum osteocalcin levels with the incidence of MACE. A total of 247 subjects with a mean age of 65.50 ± 10.38 years were enrolled in the analysis. After a mean follow‐up time of 4.4 ± 2.6 years, MACE occurred in 175 cases. For men patients, those with serum osteocalcin levels higher than 17.22 ng/mL had significantly lower fasting plasma glucose (FPG) than those with serum osteocalcin levels lower than 17.22 ng/mL (P < .05). According to the multivariate Cox proportional hazards regression, the lower serum osteocalcin levels and the higher risk of future MACE occurred in men with CAD at baseline (hazard ratio = 0.970; 95% confidence interval 0.943‐0.999, P = .04). However, this difference was not significant either in men without CAD or in women. In conclusion, relatively lower serum osteocalcin levels were associated with a higher risk of MACE in Chinese men with CAD.     

Association of nitric oxide synthase 3 (NOS3) 894 G>T polymorphism with prognostic outcomes of anthracycline in Chinese patients with acute myeloid leukaemia

The aim of the present study was to investigate the influence of the nitric oxide synthase 3 (NOS3) 894 G>T polymorphism on prognostic outcomes of anthracycline in Chinese patients with de novo intermediate‐risk acute myeloid leukaemia (AML) and to examine the gene expression level in relation to genetic variation. In all, 225 Chinese patients with intermediate‐risk AML (at the complete remission stage) treated with anthracycline were enrolled in the study. The 894 G>T polymorphism of the NOS3 gene was analysed by allele‐specific matrix‐assisted laser desorption ionization time‐of‐flight. Expression of NOS3 mRNA was tested in 72 patients of known genotype for NOS3 894 G>T. The clinical characteristics of these patients were obtained from medical records. Survival analysis showed that patients with AML (GG genotype) had a longer overall survival (OS; P = 0.006). After adjusting for age, gender, leucocyte count, haemoglobin level, platelet level, French, American and Britain (FAB) classification, lactate dehydrogenase levels, Eastern Cooperative Oncology Group Performance Status, nucleophosmin gene and fms‐related tyrosine kinase 3 gene, multivariate survival analysis showed that the NOS3 894 G>T polymorphism appeared to be a predicting factor for OS (P = 0.014; hazard ratio = 1.856). However, no significant associations between the NOS3 894 G>T polymorphism and relapse‐free survival and relapse in patients with AML were observed. Gene expression levels were significantly higher in patients with the GG genotype than in patients with the GT and TT genotypes (P = 0.033). The findings suggest that the NOS3 894 G>T variant may be a biomarker for the prediction of OS in Chinese patients with AML.     

Effects of cigarette smoke on Holter ECG recordings in patients with arterial hypertension. Part 2: Parameters of heart rate turbulence

The studies aimed at evaluation of cigarette smoke effect on heart rate turbulence (HRT) in patients with arterial hypertension (AH). 223 consecutive individuals were qualified to the studies. The following groups of patients not suffering from other disease which may affect HRT were distinguished: 1 – patients with AH (n = 145); 2 – patients without AH (n = 48). In group 1 the following patient subgroups were studied: A – active smokers (n = 42), B – non-smokers exposed to cigarette smoke (n = 30), C – non-smokers not exposed to tobacco smoke (n = 34), D – former smokers who had quit smoking (n = 26). In every participant HRT analysis was conducted. Subgroup A manifested significantly higher values of TO and lower values of TS as compared to analogous values obtained in subgroups B–D. Subgroups B and D were characterized also by significantly higher values of TO and lower values of TS as compared to subgroup C. Active and passive cigarette smoking were found to represent independent risk factors for an abnormal HRT.ConclusionBoth active and passive exposure to tobacco smoke induces causes abnormal HRT in patients with arterial hypertension.     

Clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients

Acute coronary syndrome (ACS) has become a vital disease with high mortality worldwide. A combined antiplatelet therapy (aspirin and a P2Y₁₂ antagonist) is commonly used to prevent re‐infarction in ACS patients who have undergone percutaneous coronary intervention (PCI). Clopidogrel, a P2Y₁₂ antagonist, plays an important role in the inhibition of platelet aggregation (IPA). However, it is a pro‐drug requiring biotransformation by cytochrome P450 (CYP450). The aim of this study is to unravel the effect of clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcomes in ACS patients. In our study, a total of 196 patients with metabolic gene polymorphism of clopidogrel were enrolled, and their antiplatelet effect as well as their cardiovascular events were collected. Approximately 2 mL of venous blood samples were used for genotype detection and another 4 mL were collected for platelet reactivity with thrombelastography. The primary clinical end‐point was defined as a combination of cardiovascular mortality and revascularization for targeted vascular lesion. Based on the results of IPA, the prevalence of high on‐treatment platelet reactivity (HPR) was 17.3% and the majority of patients (82.7%) obtained normal on‐treatment platelet reactivity (NPR). The HPR group had significantly higher body mass index (BMI) and lower arachidonic acid (AA) induced IPA (P < 0.05). Therapy including Glycoprotein (GP) IIb/IIIa antagonist increased IPA (P < 0.05). ADP‐induced IPA effect was lower with the presence of CYP2C19*2, *3 and paraoxonase (PON)1 Q192R loss‐of‐function (LOF) alleles, respectively (P < 0.05). Multivariate logistic regression analysis demonstrated that aspirin resistance (AA‐induced IPA < 50%) had a greater risk of the occurrence of major adverse cardiovascular events (MACE) (OR = 3.817; 95% CI: 1.672‐8.700; P = 0.002). CYP2C19*2 LOF alleles were associated with high risk of MACE in 1‐year post PCI operations (OR = 2.571; 95% CI: 1.143‐5.780; P = 0.030). For the ACS patients, the presence of CYP2C19*2 and PON1 Q192R LOF alleles were the major drivers of HPR.     

Relationship between cigarette smoking and other coronary risk factors in atherosclerosis: risk of cardiovascular disease and preventive measures

Among the major Coronary Risk Factors (CRF) cigarette smoking has shown undoubtedly harmful effects on the heart and blood vessels either as active smoking (smoking a cigarette) or passive smoking (exposure to environmental tobacco smoke -ETS). The strong relationship between cigarette smoking and cardiovascular disease has been seen independent of the other CRF in a number of well-designated epidemiologic studies. However, a strong increase in the excess of cardiovascular risk has been defined along with the interaction of cigarette smoking and other major CRF. Thousands of pharmacologically active substances are present in tobacco smoke, and a large number of direct and indirect effects have been demonstrated. Different responses are also related to these types of exposure: active exposure or passive exposure. The cardiovascular risk increases with increasing levels of blood pressure and/or serum cholesterol and diabetes mellitus, and at each level of these three risk factors, distributed with different rates according to age and gender in individuals, the risk in active smokers or passive smokers is greater than the risk in nonsmokers. Further analytical and methodological observations are needed for better understanding of the chemical and biological synergism. Nevertheless, evidence is clear that cigarette smoking greatly increases the risk of cardiovascular diseases in individuals already at increased risk because of other CRF. Preventive measures must be absolutely conducted to prevent the CRF interaction. These are the changes in lifestyle (i.e. to give up smoking and make physical activity), drug administration, diet supplementation especially by those substances with antioxidant effects.     

Impact of non‐cardiovascular surgery on reactive hyperaemia and arterial endothelial function

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Pharmacokinetic interactions between clozapine and sertraline in smokers and non‐smokers

Clozapine is an effective antipsychotic drug for treatment‐resistant schizophrenia. Sertraline is a widely prescribed antidepressant and often concomitantly applied to address negative symptoms or depression. However, data on interactions between clozapine and sertraline are inconsistent. The aim of our study was to evaluate pharmacokinetic interactions between clozapine and sertraline analysing a therapeutic drug monitoring database of 1644 clozapine‐medicated patients. We compared four groups: non‐smokers (n = 250) and smokers (n = 326) with co‐medication without known effects on cytochrome P450 and without sertraline, and non‐smokers (n = 18) and smokers (n = 17) with sertraline co‐medication. Measured and dose‐corrected concentrations (C/D) of clozapine were compared between the groups using non‐parametrical tests with a significance level of 0.05. Post hoc analyses included pairwise comparisons to account for smoking status. Although we detected significant differences for clozapine levels and C/D values between study groups (P < .001 for Kruskal‐Wallis test in both cases), post hoc analyses revealed no differences for concentrations and C/D values of clozapine (P > .05 for Mann‐Whitney U test in both cases). A negative correlation between the sertraline dose and the clozapine concentration was found in non‐smokers (Spearman's rank correlation, rs = ?0.535, P = .048). A potential pharmacokinetic interaction between clozapine and a standard therapeutic sertraline dose seems to be of minor clinical importance.     

Places and social contexts associated with simultaneous use of alcohol,tobacco and marijuana among young adults

Introduction and Aims. Little is known about social–ecological correlates of simultaneous use of alcohol with other substances. This study examined places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. Design and Methods. We used survey data obtained from 1538 young adult recent alcohol drinkers (49% male; 18–30 years old) in 24 non‐contiguous cities in California. Event‐level measures included alcohol, tobacco and marijuana use, drinking places and social characteristics of the event. Individual‐level measures included alcohol expectancies, depression and demographics. Results. Bars and restaurants had less alcohol and marijuana use (odds ratio = 0.34; 95% confidence interval 0.18, 0.62; P < 0.001) and alcohol, marijuana and tobacco use (odds ratio = 0.27; 95% confidence interval 0.14, 0.54; P < 0.001) compared with alcohol use only. Perceived percent of intoxicated people at an event was associated with greater likelihood of using alcohol with tobacco and marijuana at the event. At the individual level, greater age was generally associated with increased odds of simultaneous use. Participants who were male, less educated, more depressed and had positive alcohol expectancies were more likely to simultaneously co‐use alcohol with tobacco and marijuana. Those with negative expectancies were less likely to simultaneously use these substances. Discussion and Conclusions. Social events in private settings with a high percentage of people who are intoxicated had increased likelihood of simultaneous use of alcohol, tobacco and marijuana. Prevention efforts in these settings may reduce simultaneous use of these substances and related harms. [Lipperman‐Kreda S, Paschall MJ, Saltz RF, Morrison CN. Places and social contexts associated with simultaneous use of alcohol, tobacco and marijuana among young adults. Drug Alcohol Rev 2017;00:000–000]     

冠心病危险因素与预后相关性的分析

目的：探讨冠心病危险因素与预后相关性情况。方法分析本院2010年4月~2013年4月诊治的冠心病患者200例临床资料。结果男性患者、年龄≥60岁、高血压、糖尿病、吸烟、颈动脉斑块、高血脂患者冠心病发生率较高, P〈0.05,差异均有统计学意义。结论男性患者、年龄≥60岁、高血压、糖尿病、吸烟、颈动脉斑块、高血脂是冠心病常见的高危风险因素,其和冠心病预后具有密切的关系。     

Uric acid as an independent predictor of coronary artery disease in essential hypertension: Data from an 8‐year‐follow‐up study

The role of serum uric acid (SUA) in cardiovascular risk prediction remains to be further determined. We assessed the predictive value of SUA for the incidence of coronary artery disease (CAD) in 2287 essential hypertensive patients who were followed up for a mean period of 8 years. The distribution of SUA levels at baseline was split by the median (5.2 mg/dL) and subjects were classified into those with high and low values. Hypertensives who developed CAD (n = 57) compared to those without CAD at follow‐up (n = 2230) had at baseline higher SUA. In multivariate Cox regression model, among established confounders, high SUA (hazard ratio = 1.216, P = .016) turned out to be independent predictor of CAD. In essential hypertensive patients SUA independently predicts CAD.     

KCNJ11 E23K variant is associated with the therapeutic effect of sulphonylureas in Chinese type 2 diabetic patients

The aim of the present study was to investigate the effect of the E23K variant of the potassium inwardly rectifying channel, subfamily J, member 11 (KCNJ11) gene on gliclazide modified release (MR) treatment in newly diagnosed patients with type 2 diabetes mellitus (T2DM). A total of 108 diabetic patients with no history of antidiabetic medication was treated with gliclazide MR for 16 weeks and underwent follow up at Weeks 2, 4, 8, 12 and 16. All patients were genotyped for KCNJ11 E23K (rs5219). At baseline, patients with the KK genotype had higher blood glucose and lower serum insulin levels after oral glucose administration than patients with the EE and EK genotypes (P < 0.05 for all). During treatment, individuals with the KK genotype had lower fasting glucose levels and were more likely to attain the target fasting glucose level (P_{log rank} = 0.028) than E allele carriers. Patients with the KK genotype had larger augmentations in changes (Δ) in acute insulin response (P = 0.049) and Δ body mass index (P = 0.003). Moreover, patients with the EK genotype had a lower variance in changes in fasting insulin levels (P = 0.049) and homeostasis model assessment of β‐cell function (P = 0.021) than those with the KK genotype. The findings of the present study suggest that the KCNJ11 E23K variant is associated with a greater effect of sulphonylurea treatment in newly diagnosed Chinese patients with T2DM.     

INERTIA OR INACTION? BLOOD PRESSURE MANAGEMENT AND CARDIOVASCULAR RISK IN DIABETES‡

• 1 Diabetes is a significant risk factor for cardiovascular disease (CVD), but the presence of comorbidities, such as hypertension, markedly increases CVD risk. The aim of the present study was to determine the effectiveness of hypertension management in patients with diabetes.
• 2 The cvTRAC Study was a cross‐sectional study of CVD risk factors in primary care practices across Australia. General medical practitioners enrolled patients they considered to be at increased risk of CVD and reported on cardiovascular disease history, CVD risk factor levels and current therapy.
• 3 In all, 9857 men and 8332 women with diabetes participated in the study, with > ;85% having at least two CVD risk factors in addition to diabetes and 68% having a history of hypertension. Lost therapeutic benefit in diabetes patients with hypertension was seen in those who were failing to meet targets on antihypertensive drug therapy (therapeutic inertia: > ;73% of the hypertensive cohort), with a smaller proportion accounted for by those who met prescribing guidelines but were not being treated pharmacologically (treatment gap: 5.4% of the hypertensive cohort). Lack of compliance with lifestyle guidelines was estimated to account for over 8% of those not meeting blood pressure targets. Age (odds ratio (OR) 0.983, 95% confidence interval (CI) 0.980–0.986; P < 0.001), compliance with physical activity guidelines (OR 1.219, 95% CI 1.088–1.366; P = 0.001) and compliance with dietary guidelines (OR 1.298, 95% CI 1.188–1.420; P < 0.001) were independent predictors of target blood pressure attainment in the diabetic population.
• 4 Deficiencies in pharmacological and lifestyle‐related therapeutic strategies contribute to suboptimal hypertension management in diabetes. Therapeutic inertia is a greater contributor to lost therapeutic benefit than treatment gap in this population.

     

Risk factors for linezolid‐induced thrombocytopenia in patients without haemato‐oncologic diseases

This study aimed to describe the occurrence and to evaluate the predictive factors of thrombocytopenia caused by parenteral linezolid in hospitalised patients without haemato‐oncologic diseases. Using electronic medical records, a retrospective safety evaluation was performed among all hospitalised adult patients who received parenteral linezolid therapy between January 2005 and June 2016. Of all identified 264 patients with an average age of 63.4 (SD 15.8) years, thrombocytopenia occurred at a rate of 29.2% after an average of 11.2 (SD 7.4) days of the initiation of linezolid therapy. Significant predictive factors for thrombocytopenia included the duration of linezolid therapy longer than or equal to 7 days (adjusted odds ratios [ORs] 7.25, 19.51 and 28.80; 95% confidence intervals [CIs] 1.92‐27.38, 4.76‐79.95 and 6.48‐127.92 for 7‐13 days, 14‐20 days and ≥21 days, respectively; P < 0.01 for all values), baseline platelet count <150 × 10³/mm³ (adjusted OR, 5.08; 95% CI, 2.06‐12.55; P < 0.001), creatinine clearance <30 mL/min (adjusted OR, 4.19; 95% CI, 1.59‐11.06; P = 0.004) and concurrent low‐dose aspirin therapy (adjusted OR, 2.99; 95% CI, 1.26‐7.08; P = 0.013). Baseline platelet count less than 150 × 10³/mm³ was an independent predictor of early‐onset (≤6 days) thrombocytopenia (adjusted OR, 5.07; 95% CI, 1.46‐17.58; P = 0.011). Closer monitoring of platelet count is required in patients who receive parenteral linezolid therapy for 7 days or more, and have low baseline platelet counts or impaired renal function.     

Effects of cigarette smoke on Holter ECG recordings in patients with arterial hypertension. Part 1: Time domain parameters of heart rate variability

This report was intended to evaluate the effect of cigarette smoke on heart rate variability (HRV) in patients with arterial hypertension (AH). 223 individuals were qalified to the studies. The following groups of patients not suffering from other disease which may affect HRV were delineated: 1 – patients with AH (n = 145); 2 – patients without AH (n = 48). In group 1 the following patient groups were studied: A – active smokers (n = 42), B – non-smokers exposed to cigarette smoke (n = 30), C – non-smokers not exposed to tobacco smoke (n = 34), D – former smokers (n = 26). A time domain HRV analysis was carried out. Group 1 versus group 2 manifested significantly lower mean values of most parameters in the HRV time domain analysis. Subgroups A, B and D versus subgroup C also exhibited significantly lower mean values of most parameters in the HRV time domain analysis. Active cigarette smoking and passive exposure to tobacco smoke represented independent risk factors for a decreased HRV. Conclusions: Active and passive exposure to cigarette smoke decreases HRV in hypertensive patients.     

2型糖尿病合并胆囊结石患者颈动脉改变的超声特征

目的探讨2型糖尿病合并胆囊结石患者颈动脉改变的超声特征。方法对48例2型糖尿病合并胆囊结石患者行颈动脉超声检查(Ⅰ组),另随机安排45例患有2型糖尿病但不合并胆囊结石的患者做对照组(Ⅱ组),检测两组的粥样硬化斑块形成情况、IMT、PSV、EDV及RI。结果Ⅰ组颈动脉IMT增厚者为39例,占81%,粥样硬化斑块检出率为56%,Ⅱ组IMT增厚者为25例,占56%,粥样硬化斑块检出率为37%,Ⅰ组较Ⅱ组IMT增厚人数及粥样硬化斑块检出率明显增高(P<0.05),而PSV、EDV及RI值差异无统计学意义(P>0.05)。结论 2型糖尿病合并胆囊结石患者颈动脉结构变化较不合并胆囊结石患者明显,提示血糖及胰岛素水平越高该类患者罹患心脑血管病变的风险越大,利用超声行颈动脉检查,对其心脑血管等病变的诊断及治疗具有指导意义。     

Assessment of a medication management program targeting hypertension and diabetes patients: Impact on medication adherence

BackgroundThe National Health Insurance Service in South Korea has conducted a telephone outreach program to improve medication adherence for hypertension and diabetes patients since 2014.ObjectivesTo evaluate the direct outcomes of the program.MethodsPatients were identified among those who visited an outpatient clinic at least twice or used an inpatient service at least once for hypertension or diabetes during 6-month intervals and who were nonadherent based on the proportion of days covered (PDC) calculated. As a preliminary intervention, participants were mailed an information leaflet on their own medication adherence and other tips for effective self-management of chronic diseases. For the intervention, two phone calls and three phone messages were made to patients by 24 participating regional offices. Ultimately, 2,428 hypertension patients and 884 diabetes patients received the intervention. Propensity matching was used based on age, sex, and the Charlson Comorbidity Index to select 12,140 hypertension and 4,420 diabetes patients as controls in the non-participating regions. The outcome was PDC. Multivariate ordinary least squares or logistic regression analysis were used with difference-in-difference specification.ResultsThe adjusted quarterly PDC increased by 1.96%p for hypertension (p = 0.023) and by 7.79%p for diabetes patients (p < 0.001). Approximately 40.6% and 51.7% of hypertension and diabetes patients in the treatment arm (p = 0.0069) became adherent after the intervention, whereas the corresponding proportions were 37.7% and 41.4% (p < 0.001) in the control group. Both treatment groups showed a higher likelihood of good medication adherence (hypertension: odds ratio = 1.157, 95% CI [1.058, 1.265]; diabetes: odds ratio = 1.532, 95% CI [1.323, 1.774]). The control group, who received only a print intervention with a mailed leaflet, also showed a dramatic increase in medication adherence.ConclusionsAn insurer-coordinated telephone-administered program resulted in improvement of medication adherence among patients with hypertension and diabetes.     

Hormonal, cardiovascular, and subjective responses to acute stress in smokers

Rationale  There are complex relationships between stress and smoking; smoking may reduce the emotional discomfort of stress, yet nicotine activates stress systems and may alter responses to acute stress. It is important to understand how smoking affects physiological and psychological outcomes after stress and how these may interact to motivate smoking. Objectives  This study aimed to examine the magnitude and time course of hormonal, cardiovascular, and psychological responses to acute psychosocial stress in smokers and non-smokers to investigate whether responses to acute stress are altered in smokers. Materials and methods  Healthy male non-smokers (n = 20) and smokers (n = 15) participated in two experimental sessions involving a standardized public speaking stress procedure and a control non-stressful task. The outcome measures included self-reported mood, cardiovascular measures (heart rate and blood pressure), and plasma hormone levels (noradrenaline, cortisol, progesterone, and allopregnanolone). Results  Smokers exhibited blunted increases in cortisol after the Trier Social Stress Test, and they reported greater and more prolonged subjective agitation than non-smokers. Stress-induced changes in progesterone were similar between smokers and non-smokers, although responses overall were smaller among smokers. Stress did not significantly alter levels of allopregnanolone, but smokers exhibited lower plasma concentrations of this neurosteroid. Conclusions  These findings suggest that smoking dampens hormonal responses to stress and prolongs subjective discomfort. Dysregulated stress responses may represent a breakdown in the body’s ability to cope efficiently and effectively with stress and may contribute to smokers’ susceptibility to acute stress, especially during abstinence.