smoking – ABC CARDIOL

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Editorial

Hypertension as another Facet of Passive Smoking

Gilson Soares Feitosa

Smoking and hypertension are recognized risk factors for the development of cardiovascular disease. Efforts have been made to clarify their potential harm, as well as the benefits resulting from their control among the general population.

Passive smoking has received less attention regarding its harmful role. Initially, the focus was on irritation of the rhino and nasopharynx, and only more recently, on lung-related problems and cardiovascular diseases.

[…]

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IJCS

Brief Communication

Acute Effect of Resistance Exercise on Mucociliary Clearance in Active Smokers

Alessandra Mayumi Marques Masuda et al. Iara Buriola Trevisan Tamara dos Santos Gouveia Guilherme Yassuyuki Tacao … Ercy Mara Cipulo Ramos Dionei Ramos

Abstract

Background:

Nasal mucociliary clearance (NMC) responds to autonomic activity through exercise. However, there is a gap in the literature on how NMC responds to resistance exercise.

Objective:

To evaluate the acute effects of resistance tube exercise on NMC and the autonomic nervous system in smokers.

Methods:

Clinical trial was performed with 18 individuals. Personal, anthropometric, and smoking history data were collected, and a pulmonary function test was performed by spirometry. The fatigue resistance test was performed in order to obtain the number of repetitions for the prescription of exercise. Heart rate variability was captured using a monitor. Subsequently, the exhaled carbon monoxide (exCO) was measured and a saccharin transit test (STT) was performed for NMC.

Results:

The non-smoking group presented a significant decrease of 4.0±3.2 minutes in STT after P1 (p=0.021). Regarding HRV, the smoking group presented a significant decrease of mean RR (−90.3±53.0; p=0.011), SDNN (−560.0±1333.2; p=0.008), RMSSD (−13.6±10.5; p=0.011), LFms² (−567.3±836.1; p=0.008), HFms² (−223.8±231.8; p=0.008), SD1 (−9.7±7.4; p=0.011) and SD2 (−20.7±17.0; p=0.008), and an increase of mean HR (10.2±5.9; p=0.011) after P2. In the non-smoking group, a significant decrease was observed in the mean RR (−67.1±70.7; p=0.038), SDNN (−16.8±15.0; p=0.015), RMSSD (−12.3±14.7; p=0.011), LFms² (−831.2±1347.5; p=0.015), SD1 (−8.7±10.4; p=0.011), and SD2 (−22.0±19.1; p=0.015), while an increase in HR (7.1±7.3; p=0.028) was found after P1.

Conclusions:

The intensity of the resistance exercise applied to the patient was not enough to promote changes in smokers. By contrast, in non-smokers, the same intensity of exercise was effective in promoting alterations in the NMC and autonomic activity. (Int J Cardiovasc Sci. 2021; 34(2):223-230)

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Original Article

Influence of Smoking Consumption and Nicotine Dependence Degree in Cardiac Autonomic Modulation

Ana Paula Soares dos Santos et al. Dionei Ramos Gabriela Martins de Oliveira Ana Alice Soares dos Santos … Ana Paula Coelho Figueira Freire Juliana Tiyaki Ito Renato Peretti Prieto Fernandes Luiz Carlos Marques Vanderlei Ercy Mara Cipulo Ramos

Abstract

Background:

Smoking consumption alters cardiac autonomic function.

Objective:

Assess the influence of the intensity of smoking and the nicotine dependence degree in cardiac autonomic modulation evaluated through index of heart rate variability (HRV).

Methods:

83 smokers, of both genders, between 50 and 70 years of age and with normal lung function were divided according to the intensity of smoking consumption (moderate and severe) and the nicotine dependency degree (mild, moderate and severe). The indexes of HRV were analyzed in rest condition, in linear methods in the time domain (TD), the frequency domain (FD) and through the Poincaré plot. For the comparison of smoking consumption, unpaired t test or Mann-Whitney was employed. For the analysis between the nicotine dependency degrees, we used the One-way ANOVA test, followed by Tukey’s post test or Kruskal-Wallis followed by Dunn’s test. The significance level was p < 0,05.

Results:

Differences were only found when compared to the different intensities of smoking consumption in the indexes in the FD. LFun (62.89 ± 15.24 vs 75.45 ± 10.28), which corresponds to low frequency spectrum component in normalized units; HFun (37.11 ± 15.24 vs 24.55 ± 10.28), which corresponds to high frequency spectrum component in normalized units and in the LF/HF ratio (2.21 ± 1.47 vs 4.07 ± 2.94). However, in the evaluation of nicotine dependency, significant differences were not observed (p > 0.05).

Conclusion:

Only the intensity of smoking consumption had an influence over the cardiac autonomic modulation of the assessed tobacco smokers. Tobacco smokers with severe intensity of smoking consumption presented a lower autonomic modulation than those with moderate intensity.

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Artigo Original

Smoking is associated with remodeling of gap junction in the rat heart: smoker's paradox explanation?

Rosangela Novo et al. Cristiana M. Freire Sergio Felisbino Marcos F. Minicucci … Paula S. Azevedo Leonardo A. M. Zornoff Sergio A. R. Paiva

BACKGROUND: In a previous study utilizing the rat model, exposure to tobacco smoke for 5 weeks increased survival after AMI, despite similar age and infarct size between the smokers and nonsmokers, and absence of reperfusion. OBJECTIVE: Thus, this study aimed to analyze the effects of exposure to tobacco smoke on intensity, distribution or phosphorylation of connexin 43 in the rat heart. METHODS: Wistar rats weighing 100 g were randomly allocated into 2 groups: 1) Control (n = 25); 2) Exposed to tobacco smoke (ETS), n = 23. After 5 weeks, left ventricular morphometric analysis, immunohisthochemistry and western blotting for connexin 43 (Cx43) were performed. RESULTS: Collagen volume fraction, cross-sectional areas, and ventricular weight were not statistically different between control and ETS. ETS showed lower stain intensity of Cx43 at intercalated disks (Control: 2.32 ± 0.19; ETS: 1.73 ± 0.18; p = 0.04). The distribution of CX43 at intercalated disks did not differ between the groups (Control: 3.73 ± 0.12; ETS: 3.20 ± 0.17; p = 0.18). ETS rats showed higher levels of dephosphorylated form of Cx43 (Control: 0.45 ± 0.11; ETS: 0.90 ± 0.11; p = 0.03). On the other hand, total Cx43 did not differ between control and ETS groups (Control: 0.75 ± 0.19; ETS: 0.93 ± 0.27; p = 0.58). CONCLUSION: Exposure to tobacco smoke resulted in cardiac gap junction remodeling, characterized by alterations in the quantity and phosphorylation of the Cx43, in rats hearts. This finding could explain the smoker’s paradox observed in some studies.

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Atualização

Smoking: what has been addressed in brazilian journals

Gustavo Faibischew Prado et al. Elisa Maria Siqueira Lombardi Anna Miethke Morais Stella Regina Martins Ubiratan de Paula Santos

The topic of tobacco smoking, in its several aspects, has been receiving increasing attention among researchers over the past few years, which has been reflected in more data and more solid scientific literature on the subject in national journals. This article aims to review the studies that focused on smoking published between January 2010 and June 2012, in Arquivos Brasileiros de Cardiologia (Brazilian Archives of Cardiology), Brazilian Journal of Medical and Biological Research, Clinics (Sao Paulo), Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology), Revista da Associação Médica Brasileira (Journal of the Brazilian Medical Association) and Revista Brasileira de Cirurgia Cardiovascular (Brazilian Journal of Cardiovascular Surgery). During the aforementioned period 58 articles were published, 52 of which were original ones, addressing several aspects of smoking, such as effects on health, epidemiology, cessation and experimental studies.

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Artigo Original

Acute effects of smoking on autonomic modulation: analysis by poincare plot

Beatriz Martins Manzano et al. Luiz Carlos Marques Vanderlei Ercy Mara Ramos Dionei Ramos

BACKGROUND: Smoking affects the autonomic function. OBJECTIVE:To investigate the acute effects of smoking on the autonomic modulation and the post-smoking recovery of the heart rate variability (HRV) index through Poincare plot and linear indices. METHODS: A total of 25 young smokers underwent beat-to-beat analysis of heart rate in the sitting position after 8 hours of tobacco abstinence, for 30 minutes at rest, 20 minutes while smoking and 30 minutes after smoking. The analysis of variance for repeated measures, followed by Tukey’s test or Friedman’s test followed by Dunn’s test, were applied depending on the normality of data, with p < 0.05. RESULTS: While smoking, there was a decrease in the indices: SD1 (23.4 ± 9.2 vs 13.8 ± 4.8), SD1/SD2 ratio (0.31 ± 0.08 vs 0.2 ± 0.04), RMSSD (32,7 ± 13 vs 19.1 ± 6.8), SDNN (47.6 ± 14.8 vs 35.5 ± 8.4), HFnu (32,5 ± 11.6 vs 19 ± 8.1) and the RR interval (816.8 ± 89 vs 696.5 ± 76.3) in relation to the rest period, whereas increases in the LFnu index (67.5 ± 11.6 vs 81 ± 8.1) and the LF/HF ratio (2.6 ± 1.7 vs 5.4 ± 3.1) were observed. The visual analysis of the plot showed a lower dispersion of RR intervals while smoking. Except for the SD1/SD2 ratio, the other indices presented recovery of values 30 minutes after smoking. CONCLUSION: Smoking resulted in acute modifications of the autonomic control, characterized by sympathetic activation and vagal withdrawal, presenting recovery 30 minutes after smoking.

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Artigo Original

Remodeling pattern and ventricular function in rats exposed to cigarette smoke

Paula S. Azevedo et al. Marcos F. Minicucci Beatriz B. Matsubara Luiz S. Matsubara … Daniella R. Duarte Sergio A. R. Paiva Leonardo A. M. Zornoff

BACKGROUND: The relevance of the remodeling pattern in the model of rats exposed to cigarette smoke is not known. OBJECTIVE: Analyzing the presence of different remodeling patterns in this model and its relation with the ventricular function. METHODS: Smoking rats (n=47) have been divided according to the geometry pattern, analyzed by echocardiogram: normal (normal mass index and normal relative wall thickness), concentric remodeling (normal mass index and increased relative wall thickness), concentric hypertrophy (increased mass index and increased relative wall thickness) and eccentric hypertrophy (increased mass index and normal relative wall thickness). RESULTS: Smoking rats presented one of the following geometry patterns: normal pattern, 51%; eccentric hypertrophy; 32%; concentric hypertrophy, 13% and concentric remodeling, 4%. The normal and eccentric hypertrophy groups presented smaller ejection fraction values and fractional shortening than the concentric hypertrophy group. Thirteen animals (28%) presented systolic dysfunction detected by the ejection fraction and by fractional shortening. In the single regression analysis, geometry patterns and mass index could not predict ventricular dysfunction (p<). On the other hand, the increased relative thickness of the wall could predict ventricular dysfunction in the single regression analysis (p<0,001) and in the multiple regression analysis after adjustment to the mass index (p=0,003). CONCLUSION: Rats exposed to cigarette smoke presented one of the four different remodeling patterns. Among the geometric variables analyzed, only the increased relative thickness of the left ventricle wall could predict ventricular dysfunction in this model.

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Artigo Original

Effects of the administration of beta-blockers on ventricular remodeling induced by cigarette smoking in rats

Daniella R. Duarte et al. Lucienne C. Oliveira Marcos F. Minicucci Paula S. Azevedo … Beatriz B. Matsubara Luiz S. Matsubara Álvaro O. Campana Sergio A. R. Paiva Leonardo A. M. Zornoff

BACKGROUND: The role of the adrenergic system on ventricular remodeling induced by cigarette smoking is unknown. OBJECTIVES: To investigate the influence of propranolol on ventricular remodeling induced by exposure to tobacco smoke. METHODS: Rats were divided into three groups: 1) C, n=10 – control group; 2) F, n=10 – animals exposed to tobacco smoke; 3) BB, n=10 – animals receiving propranolol and exposed to tobacco smoke (40 mg/kg/day). After 2 months, the animals underwent echocardiographic and morphometric analyses. One-way ANOVA (mean ± standard deviation) or the Kruskal-Wallis test (median and interquartile interval) was used. RESULTS: Group BB showed a lower heart rate than group F (C = 358 ± 74 bpm, F = 374 ± 53 bpm, BB = 297 ± 30; P = 0.02). Group F showed greater end-diastolic diameters (C = 18.6 ± 3.4 mm/kg, F = 22.8 ± 1.8 mm/kg, BB = 21.7 ± 1.8 mm/kg; P = 0.003) and left ventricular (LV) end-systolic diameters (C = 8.6 ± 2.1 mm/kg, F = 11.3 ± 1.3 mm/kg, BB = 9.9 ± 1.2 mm/kg; P = 0.004), adjusted for body weight (BW) and a tendency towards a lower ejection fraction (C = 0.90 ± 0.03, F = 0.87 ± 0.03, BB =0.90 ± 0.02; P = 0.07) than group C. Group BB showed a tendency towards a lower LV/BW ratio than group F (C = 1.94 (1.87 – 1.97), F = 2.03 (1.9-2.1) mg/g, BB = 1.89 (1.86-1.94); P = 0.09). CONCLUSION: Administration of propranolol attenuated some of the variables of ventricular remodeling induced by the exposure to tobacco smoke in rats.

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Artigo Original

Exposition to smoking and attitudes: comparison between inquiries applied to adult population in São Paulo City, 1987 and 2002

Luiz Francisco Marcopito et al. Ana Paula Coutinho Dalva Maria de Oliveira Valencich Marco Antonio de Moraes … Rodolfo Brumini Sandra Aparecida Ribeiro

BACKGROUND: Periodic monitoring of tobacco smoking in the population is of public health interest. OBJECTIVES: To compare the prevalence of smoking habits and attitudes toward tobacco smoking from a sample of residents of the City of Sao Paulo, in 1987 and 2002. METHODS: Two random sampling household surveys were carried out among residents of the City of Sao Paulo, in 1987 and 2002, respectively with 1,471 and 2,103 participants aged 15-59 years RESULTS: Age-adjusted prevalence of tobacco smoking dropped from 41.8% (in 1987) to 25.5% (in 2002) among males and, respectively, from 30.6% to 19.8% among females, and such reduction was observed in all education levels. There was a decrease in the mean number of cigarettes smoked a day among men (but an increase among women), There was a growth in the preference for low tar cigarettes, an increase in those who quit smoking in the last 10 years, a growth among those who seriously tried to quit smoking, and an increase in those who believe in that “smoking is dangerous for your health”. CONCLUSION: There was a favorable change in the situation of smoking habits in the City of Sao Paulo from 1987 to 2002.

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Artigo Original

Prevalence of cardiovascular risk factors in adults living in Luzerna, Santa Catarina, in 2006

João Rogério Nunes Filho et al. Daniela Debastiani Alessandra Daros Nunes Karen Glazer Peres

OBJECTIVES: To estimate the prevalence of cardiovascular risk factors in the adult population of Luzerna, in the state of Santa Catarina. METHODS: A cross-sectional study with adults of both genders aged 20 to 59 years (n = 411). The prevalence of hypertension, diabetes, dyslipidemia, obesity, increased waist circumference, and smoking was estimated. Study variables were checked for frequency distribution, and a chi-square test for association was performed. RESULTS: The response rate was 85.9%. The following prevalences were found: hypertension: 14.7%; diabetes: 2.3%; dyslipidemia: 18.7%; obesity: 15.6%; increased waist circumference: 24.1%; and smoking: 15.6%. A total of 52.4% of the subjects had none of the risk factors; 22.4% had one risk factor, and 13.6%, 6.8%, and 4.9% had two, three, and four or more associated risk factors, respectively. CONCLUSION: The study sample showed low prevalence of hypertension and diabetes and less clustering of risk factors in the same individual, as compared with other data reported in the literature.

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Artigo Original

Effects of beta-carotene and smoking on heart remodeling after myocardial infarction

Leonardo A. M. Zornoff et al. Daniella R. Duarte Marcos F. Minicucci Paula S. Azevedo … Beatriz B. Matsubara Luiz S. Matsubara Álvaro O. Campana Sergio A. R. Paiva

OBJECTIVE: To analyze the effects of beta-carotene on the ventricular remodeling process following myocardial infarction (MI) in rats exposed to cigarette smoke. METHODS: After acute myocardial infarction (AMI), the animals were divided into four groups: 1) Group C, 24 animals that were given standard diet; 2) Group BC, 26 animals that were given beta-carotene; 3) Group ECS, 26 animals that were given standard diet and were exposed to cigarette smoke; and 4) Group BC+ECS, 20 animals that were given beta-carotene and were exposed to cigarette smoke. After six months, a morphofunctional study was performed. We used a 5% significance level. RESULTS: As regards diastolic areas (DA) and systolic areas (SA), the values for the BC group were higher than those for the C group. If DA/body weight (BW) and SA/BW are considered, the values for group BC+ECS were higher than the values for group C. As regards the fractional area change, we observed significant differences between ECS (lower values) and C (higher values) and between BC (lower values) and C (higher values). Differences between groups regarding infarction size were not observed. The ECS group presented higher values for myocyte cross-section area (MCA) than control animals. Additionally, the BC+ECS group presented higher MCA values than the BC, ECS and C groups. CONCLUSION: After myocardial infarction, smoking and beta-carotene intensified the heart remodeling process; harmful effects of the remodeling process were heightened when the two treatments were used in conjunction.

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Artigo Original

Effectiveness of sustained-release bupropion in the treatment of smoker patients with cardiovascular disease

Jaqueline Scholz Issa et al. Glória Heloise Perez Jayme Diament Angela Giuliana Zavattieri Kátia Ulrich de Oliveira

OBJECTIVES: To evaluate the effectiveness of and tolerability to sustained-release bupropion, in smokers with cardiovascular diseases treated in a smoking cessation service, as well as to investigate variables predictive of success or failure in smoking cessation. METHODS: Sustained-release bupropion was prescribed to 100 current smokers with cardiovascular disease for 12 weeks. Patients were followed for 52 week. The variables studied were gender, age, number of cigarettes, exhaled carbon monoxide, nicotine dependence (Fagerstrom Tolerance Questionnaire), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), alcohol consumption (Alcohol Use Disorders Identification Test), number of diagnoses other than smoking, adverse events, and use of medications concomitantly with sustained-release bupropion. RESULTS: Abstinence rate was 50% at week 12 and 25% at week 52. The logistic regression analysis showed that ageing was positively associated with success, whereas the worsening of the condition, as verified by the presence of a higher number of other health conditions associated with smoking, was negatively associated with success. CONCLUSION: We conclude that the prescription of bupropion for smokers with cardiovascular diseases proved to be safe and effective, especially during the treatment period (week 12).

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Original Article

Acute Effects of Maternal Smoking on Fetal-Placental-Maternal System Hemodynamics

Janine Santos Müller et al. Marcelo Antunes Ivo Behle Lucas Teixeira Paulo Zielinsky

OBJECTIVE: To study acute hemodynamic alterations in the fetal-placental maternal system immediately after maternal exposure to nicotine. METHODS: This is a noncontrolled experimental study involving 21 pregnant smoking women, randomly selected, with uncomplicated pregnancies and without risk factors for fetal heart disease. Patients underwent ultrasound and fetal echocardiography before and after smoking a cigarette. They were asked to abstain from smoking for 12 hours before the study. The mean nicotine content of the cigarettes used in the study was 0.5mg of nicotine and 6mg of carbon monoxide. RESULTS: The average number of cigarettes smoked per a day prior to the study was 9.67. Gestational age ranged between 18 and 36 weeks. The mean maternal heart rate was elevated (P<0.001) as was the mean fetal heart rate (P=0.044). Maternal systolic blood pressure (P=0.004) and diastolic blood pressure (P=0.033) were also elevated after smoking. A decrease occurred in the systolic/diastolic ratio in the right uterine artery (P=0.014) and in the left uterine artery (P=0.039). The other hemodynamic variables remained unchanged. CONCLUSION: Cigarette smoking can cause changes in physiologic variables of fetal-placental circulation, but it does not change fetal cardiac function, in the dose of nicotine and its components used in this study. The decrease in systolic/diastolic ratio in the uterine arteries is probably related to a dose-dependent nicotine pattern.

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Artigo Original

Twenty-four hour blood pressure record for smokers and nonsmokers

Marcos Galan Morillo et al. Marisa Campos Moraes Amato Sonia Perez Cendon Filha

OBJECTIVE: To evaluate the effect of smoking on blood pressure trends during a 24-hour period, by analyzing the parameters of the ambulatory blood pressure monitoring (ABPM). METHODS: The results of 289 ABPM tests conducted on patients classified as smokers or nonsmokers were studied. The parameters analyzed were: mean 24-hour, daytime and nighttime systolic and diastolic blood pressure readings; nocturnal dipping of systolic and diastolic pressures and blood pressure load. The patients were classified in four groups according to whether or not they used antihypertensive medication: 1A – nonsmokers using medication; 1B – smokers using medication; 2A – nonsmokers not using medication; and 2B – smokers not using medication. Variables were expressed as minimum, maximum, median, mean and standard deviation values. Univariate analysis was used for comparing the smoking and nonsmoking groups. The significantly different variables from the groups were selected using multivariate analysis. The significance level adopted was 5%. RESULTS: Mean daytime systolic and diastolic blood pressures were significantly higher in the smokers, regardless of whether or not they used antihypertensive medication. Mean nocturnal blood pressure readings were similar between smokers and nonsmokers. Mean 24-hour systolic blood pressure readings were significantly higher in the smokers, regardless of whether or not they used antihypertensive medication. Nocturnal dipping was similar for all groups. Blood pressure loads were consistently and significantly higher in the smokers regardless of medication use. CONCLUSION: Mean daytime systolic and diastolic blood pressure readings were consistently higher in the smokers when compared to nonsmokers regardless of antihypertension medication use. Nocturnal dipping was similar for smokers and nonsmokers.

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Artigo Original

Cardiovascular risk factors in adolescents: biological and behavioral indicators

Dartagnan Pinto Guedes et al. Joana Elisabete Ribeiro Pinto Guedes Decio Sabbatini Barbosa Jair Aparecido de Oliveira Luiz Cláudio Reeberg Stanganelli

OBJECTIVE: To provide descriptive information and investigate to what extent behavioral risk factors for cardiovascular diseases are associated with biological risk factors in the young population. METHODS: The sample included 452 adolescents (246 girls and 206 boys) between 15 and 18 years of age selected in a high school in the city of Londrina, Paraná. Risk factors of a behavioral nature were analyzed as regards insufficient physical activity, excessive intake of fat and cholesterol and smoking. As biological risk factor indicators we used overweight, high arterial pressure levels, and adverse concentration of serum lipids and lipoproteins. RESULTS: Approximately 20% of the girls and 16% of the boys presented at least one biological risk factor for development of cardiovascular diseases. Overweight was significantly associated with excessive intake of fats, while elevated arterial pressure was related to sedentary lifestyle and smoking. Excessive intake of fat and cholesterol indicated increased risk of undesirable concentrations of serum lipids and lipoproteins. The risk associated with altered blood pressure and serum lipids and lipoprotein was increased two-fold in smokers when compared with nonsmokers. CONCLUSION: The results reinforce the need for interventions targeted at the adoption of a healthy lifestyle, including the regular practice of physical exercise, appropriate dietary patterns, and abstention from smoking as of an early age.

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Artigo Original

Study of the prevalence and multiplicity of cardiovascular risk factors in hypertensive individuals from the city of Brusque, SC, Brazil

Nilton Rosini et al. Marcos José Machado Hermes Toros Xavier

OBJECTIVE: To investigate the prevalence and multiplicity of additional risk factors (RF) in a population sample of hypertensive smokers, diagnosed and enrolled at the Hiperdia Program of the Ministry of Health, in the city of Brusque, SC, Brazil. METHODS: Determination of the anthropometrical parameters and laboratory variables recognized as cardiovascular risk factors. RESULTS: Elevated prevalence of RF in addition to systemic arterial hypertension (SAH) and smoking, configuring the multiplicity that concurs with a marked elevation of the risk of cardiovascular events in this population sample. CONCLUSION: In hypertensive populations, the prevention, identification and RF control measures must be implemented; computerized programs such as the Hiperdia/MS can help in patients’ follow-up, allowing a more stringent multidisciplinary approach, especially regarding the analysis of the attainment of treatment goals and the subsequent decrease of cardiovascular risk.

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Original Article

Comparative study of smokers, ex-smokers, and nonsmokers who have experienced myocardial infarction

Diogo Nozawa et al. Roberto Alexandre Franken Karina de Cássia Braga Ribeiro Afonso Celso Pereira … Sandra Regina Schwarzwälder Sprovieri Valdir Golin

OBJECTIVE: To assess the impact of smoking on in-hospital morbidity and mortality in patients who have experienced acute myocardial infarction and to assess the association between smoking and other cardiovascular risk factors and clinical data. METHODS: A prospective cohort study analyzed 121 patients, including 54 smokers, 35 ex-smokers, and 32 nonsmokers. RESULTS: Using the chi-square test (P<0.05), an association between smoking and the risk factors sex, age, and diabetes was documented. Among the morbidity and mortality variables, only acute pulmonary edema showed a statistically significant difference (OR=9.5; 95% CI), which was greater in the ex-smoker group than in the nonsmoker group. CONCLUSION: An association between smoking and some cardiovascular risk factors was observed, but no statistical difference in morbidity and mortality was observed in the groups studied, except for the variable acute pulmonary edema.

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Original Article

Behavior of cardiac variables in animals exposed to cigarette smoke

Sergio Alberto Rupp de Paiva et al. Leonardo Antonio Mamede Zornoff Marina Politi Okoshi Katashi Okoshi … Antonio Carlos Cicogna Alvaro Oscar Campana

OBJECTIVE: To assess the behavior of cardiac variables in animals exposed to cigarette smoke. METHODS: Two groups of Wistar rats were studied as follows: control group (C), comprising 28 animals; and smoking group (S), comprising 23 animals exposed to cigarette smoke for 30 days. Left ventricular cardiac function was assessed in vivo with transthoracic echocardiography, and myocardial performance was analyzed in vitro in preparations of isolated left ventricular papillary muscle. The cardiac muscle was assessed in isometric contractions with an extracellular calcium concentration of 2.5 mmol/L. RESULTS: No statistical difference was observed in the values of the body variables of the rats and in the mechanical data obtained from the papillary muscle between the control and smoking groups. The values of left ventricular systolic diameter were significantly greater in the smoking animals than in the control animals (C= 3.39 ± 0.4 mm and S= 3.71 ± 0.51 mm, P=0.02). A significant reduction was observed in systolic shortening fraction (C= 56.7 ± 4.2% and S= 53.5 ± 5.3%, P=0.02) and in ejection fraction (C= 0.92 ± 0.02 and S= 0.89 ± 0.04, P=0.01). CONCLUSION: The rats exposed to cigarette smoke had a reduction in left ventricular systolic function, although their myocardial function was preserved.

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Original Article

Distribution of risk factors in parents and siblings of patients with early coronary artery disease

Antonio de Padua Mansur et al. André P. L. Mattar Anderson L. Rolim Fábio R. Yoshi … José F.G. Marin Luíz Antonio M. César José Antonio F. Ramires

OBJECTIVE: Early coronary artery disease (CAD) is associated with risk factors (RF). Offspring of parents with a RF have a greater prevalence of them. However, the distribution of RF in parents and siblings of patients with early CAD is unknown. METHODS: The study comprised the parents and siblings of 42 patients with early CAD ( 5 cigarretes/day), hypercholesterolemia (total cholesterol > 200 mg/dL), hypertension (diastolic blood pressure > 90 mmHg), and diabetes (glycemia > 126 mg/dL). RESULTS: Of a total of 102 RF, 4, 3, 2, and 1 were observed in, respectively, 5, 15, 15, and 7 patients with early CAD, the most prevalent being smoking (86%) and hypercholesterolemia (83%). Diabetes was observed in 15 (36%) and hypertension in 16 (38%) patients. Smoking was more prevalent in the fathers (76%) and hypercholesterolemia in the mothers (30%). In 183 siblings, 131 RF were observed (1 patient with the disease had a mean of 4.7 siblings). The prevalences of smoking, hypertension, hypercholesterolemia, and diabetes in the siblings were, respectively, 32%, 18%, 14%, and 9%. The incidence of RF was as follows: 72 (39%) siblings had 1 RF, 25 (14%) siblings had 2 RF, and 3 (2%) siblings had 3 RF. In parents and their offspring, smoking was moderately correlated (r=0.43; P=0.02) with CAD. CONCLUSION: Smoking habit of parents is passed on to offspring, and, in association with hypercholesterolemia, it was the major cause of early CAD in offspring. High prevalence of smoking in offspring shows the potential responsibility of parents in the incidence of the disease in offspring.

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Original Article

Socioeconomic aspects of spousal concordance for hypertension, obesity, and smoking in a community of Rio de Janeiro, Brazil

Katia Vergetti Bloch et al. Carlos Henrique Klein Nelson Albuquerque de Souza e Silva Armando da Rocha Nogueira Lucia Helena Alvares Salis

OBJECTIVE: The present study aims to evaluate the environmental role in the distribution of hypertension, obesity, and smoking and spousal concordance for the presence/absence of these 3 cardiovascular risk factors. METHODS: A cross-sectional study was conducted in a community in Rio de Janeiro, Brazil. The households were randomly selected. Odds ratios were estimated to measure spousal concordance, across socioeconomic levels.. RESULTS: Overall a significant aggregation of all 3 risk factors was present. The crude odds ratio for hypertension was 1.78 (95%CI=1.02-3.08); for obesity, it was 1.80 (95%CI=1.09-2.96); and for smoking, it was 3.40 (95% CI=2.07-5.61). The spousal concordance for hypertension decreased significantly (p<0.001) from the lower to the higher educational level. In the case of obesity and smoking, the opposite was observed, although p-values for the linear trend were 0.10 and 0.08, respectively. CONCLUSION: In lower socioeconomic levels, couples are more concordant for hypertension and discordant for smoking. For hypertension and smoking, education seems to be a discriminant stronger than income, but for obesity the 2 socioeconomic indicators seem to represent different aspects of the environmental determinants of risk factor distribution.

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