Passive smoking

Absorption of harmful and irritative components of cigarette smoke by nonsmokers may result in both acute and long-term health problems. Persons with asthma or coronary artery disease are at particularly high risk of developing problems. Children living with smokers are at increased risk of persistent middle ear effusions and lower respiratory tract infections. Nonsmokers married to smokers have an increased risk of lung cancer.     

被动吸烟对血管内皮舒张功能及炎性介质的影响

目的探讨被动吸烟对健康青年人血管内皮舒张功能和白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)等炎性介质的影响。方法采用超声检测健康青年人肱动脉内径,观察被动吸烟、主动吸烟及正常对照组各30例肱动脉充血反应试验和硝酸甘油试验引起的肱动脉内径变化,同时测定并比较各组外周血清IL-6、TNF-α、CRP含量。结果各组肱动脉内径基础值及硝酸甘油试验引起的肱动脉扩张率差异均无统计学意义(P>0.05),肱动脉充血反应试验引起的血管扩张率被动吸烟组及主动吸烟组与正常对照组间差异均有统计学意义(P<0.01),而两组间差异无统计学意义(P>0.05)。主动及被动吸烟组IL-6、TNF-α、CRP含量均高于正常组(P<0.05或P<0.01),而两组间差异无统计学意义。结论被动吸烟导致健康青年人血管内皮舒张功能受损,并可引起机体的炎症反应。     

Inflammatory bowel disease and smoking

Cigarette smoking is a risk factor for Crohn's disease and can have an adverse affect on its clinical course. The recurrence of Crohn's disease is lower in non-smokers, who also have a lower risk of relapse and surgery. Further research is needed to quantify the benefits of smoking cessation among people with inflammatory bowel disease.     

Effects of smoking on regional cerebral blood flow in cerebral vascular disease patients and normal subjects

The chronic effect of smoking on the regional cerebral blood flow (r-CBF) was studied by 133-Xenon inhalation method and described with the Initial Slope Index (ISI). Fifty-two patients as the control group who had no abnormality neurologically or with CT scan, 32 patients with old cerebral infarction and 20 patients with old cerebral hemorrhage were introduced to the present study, and these patients were divided into smokers and non-smokers in each group. Those whose smoking index of 200 or more [(number of cigarettes/day) X (years of smoking history) greater than or equal to 200] were designated as smokers. ISI values were decreased significantly in smokers than non-smokers in all groups. Mean ISI value of unaffected hemisphere in smokers decreased by 16% in the infarction group and 22% in the hemorrhage group comparing to the non-smokers', respectively. In the control group, mean ISI value of right hemisphere decreased by 15% and left 14% in smokers compared to the non-smokers. The r-CBF values in 44 of the 47 smokers were found to be lower than the expected age matched values in non-smokers. Serum high density lipoprotein cholesterol value in smokers was significantly lower than that in non-smokers. We demonstrated preliminarily that the smoking chronically reduced the r-CBF. Advanced atherosclerosis associated with the smoker was suggested to affect the CBF.     

Links between passive smoking and disease: a best-evidence synthesis. A report of the Working Group on Passive Smoking

We reviewed the toxicologic, clinical, and epidemiologic evidence on the health effects of environmental tobacco smoke (ETS). For each type of exposure to environmental tobacco smoke we have sought articles in the English language reporting studies of effects on human health. Formal criteria that stressed study design, quality of execution and generalizability of results were used to select 116 scientifically admissible reports from over 2,900 articles. We concluded that: (a) there is strong evidence of an association between residential exposure to environmental tobacco smoke and both respiratory illness and reduction of lung function, and also between maternal smoking and reduced birth weight; (b) the weight of evidence is compatible with an association between active maternal smoking during pregnancy and increased infant mortality, and also between residential exposure to environmental tobacco smoke (primarily spousal smoking) and the risk of lung cancer; (c) there is evidence consistent with a relationship between exposure to environmental tobacco smoke in the workplace and respiratory symptoms, (d) the evidence is insufficient to implicate residential exposure to environmental tobacco smoke in relation to other forms of malignant disease or congenital malformations; (e) there is no evidence in the literature of an association between nonresidential exposure to environmental tobacco smoke and any form of cancer. Further studies are required to address the effects of exposure to environmental tobacco smoke, especially nonresidential exposure, in carcinogenesis and as a risk factor for atherosclerosis. Further work is also needed to improve measurement of exposure in such studies and to assess the importance of confounding factors.     

Study links smoking and cardiovascular disease

Although arrhythmic death is a common cause of death in patients with congestive heart failure (CHF), numerous trials involving prophylactic antiarrhythmic drug treatment have yielded few gains. To date, only βblockers have shown a distinct mortality-reducing effect and despite the antiarrythmic effect of βblockers, results point towards causes other than the antiarrhythmic effect in obtaining this beneficial effect. Atrial fibrillation is an often-encountered arrhythmia in patients with CHF and recent trials have cast doubt on the present treatment strategy of persistently striving to obtain sinus rhythm. This paper outlines the results of the large clinical trials dealing with antiarrhythmic drug treatment in CHF patients with or without atrial fibrillation and certain subgroup analysis and future treatment possibilities are discussed.     

Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease

Despite declines in smoking prevalence in many Western countries, tobacco use continues to grow in global importance as a leading preventable cause of cardiovascular disease. Tobacco smoke is both prothrombotic and atherogenic, increasing the risks of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease. Even very low doses of exposure increase the risk of acute myocardial infarction. However, smoking cessation and second-hand smoke avoidance swiftly reduce this risk. While promising new agents are emerging, proven cost-effective and safe cessation interventions already exist, such as brief physician advice, counseling and nicotine replacement therapy. These should be routinely offered, where available, to all smokers. This is especially important for those at risk of, or with established and even acute, cardiovascular disease. Clinicians must play a more active role than ever before in supporting complete cessation in patients who smoke and in advocating for stronger tobacco control measures.     

Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease

Despite declines in smoking prevalence in many Western countries, tobacco use continues to grow in global importance as a leading preventable cause of cardiovascular disease. Tobacco smoke is both prothrombotic and atherogenic, increasing the risks of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease. Even very low doses of exposure increase the risk of acute myocardial infarction. However, smoking cessation and second-hand smoke avoidance swiftly reduce this risk. While promising new agents are emerging, proven cost-effective and safe cessation interventions already exist, such as brief physician advice, counseling and nicotine replacement therapy. These should be routinely offered, where available, to all smokers. This is especially important for those at risk of, or with established and even acute, cardiovascular disease. Clinicians must play a more active role than ever before in supporting complete cessation in patients who smoke and in advocating for stronger tobacco control measures.     

Diabetes and vascular disease

Type 2 diabetes has reached epidemic proportions and is now recognized as a coronary heart disease equivalent. While the most common metabolic abnormality associated with diabetes is hyperglycemia, there are also abnormalities in carbohydrate, fat and protein metabolism. These abnormalities increase oxidative stress and activate the renin-angiotensin system leading to endothelial dysfunction and, thereafter, to systemic atherosclerosis. This systemic atherosclerosis is responsible for the increased cardiovascular morbidity and mortality related to diabetes. In this article, we review the evidence and discuss the rationale for comprehensive risk reduction to prevent and treat vascular disease in individuals with diabetes mellitus. The components of comprehensive risk reduction strategy consist of lifestyle changes, glycemic control, control of dyslipidemia and hypertension.     

Freebased cocaine smoking and reactive airway disease

The case of a 19-year-old white female who presented with marked respiratory distress and pleuritic chest pain following freebased cocaine smoking is presented. A ventilation-perfusion scan revealed radioactive aerosol trapping in the large airways with multiple ventilation defects of the small airways, a finding compatible with reactive airway disease of the large airways and concomitant mucous plugging of the small airways. Freebased cocaine, impurities of the freebasing process, or admixtures to the freebased cocaine provided prior to smoking, are proposed as possible etiologies in what appears to be a condition of environmentally induced reactive airway disease, a previously unreported effect of cocaine use.     

Ethnicity and peripheral vascular disease

There are well-documented differences in the prevalence of coronary artery disease and carotid disease between caucasians, Afro-Caribbeans and Indo-Asians. Very little data are available on ethnic differences in peripheral vascular disease (PVD). To investigate this further, we surveyed 200 consecutive patients attending the vascular surgery service at a city centre hospital serving a multiethnic patient catchment population. All patients had proven PVD, with an ankle brachial pressure index of less than 0.8. Within this cohort, Afro-Caribbeans presented more frequently with PVD compared with the proportion of this ethnic group in the local population (p = 0.013), with a greater proportion with diabetes mellitus than in the other two ethnic groups. There did not appear to be a significant difference between the ethnic groups in any of the other established risk factors or associations (i.e. treated hypertension, smoking, previous history of ischaemic heart disease, atrial fibrillation, previous history of cerebrovascular accident or transient ischaemic attack) with PVD. As with coronary artery disease and carotid disease, there are ethnic differences in the prevalence of PVD, and the underlying risk factors, between caucasians, Afro-Caribbeans and Indo-Asians. Furthermore, patients of Afro-Caribbean origin present more frequently with symptomatic PVD than do either caucasians or Indo-Asians.