The impact of smoking on endothelial function in cerebrovascular pathology: 616.8-092

Abstract

Summary. Background. Smoking is one of the leading modifiable risk factors for cerebrovascular pathology (CVP). Endothelial dysfunction and changes in hemostasis parameters, the association of which with smoking is still unclear, play the most important role in the realization of ischemic CVP. Objective: to analyze hemostasis and endothelial function biomarkers and their association with smoking in healthy individuals and in patients with CVP. Patients/Methods. The cross-sectional study included 183 people (136 men and 47 women), whose average age was 54.10 ± 1.53 years: 109 patients (72 men and 37 women) with ischemic stroke (IS) in anamnesis, and 74 apparently healthy individuals (64 men and 10 women). Blood fibrinogen level, hematocrit (Ht), blood viscosity (BV), platelet aggregation (PA) with adrenaline and ADP (inductors), erythrocyte aggregation (EA) were determined in all examined persons. The cuff test (CT) was used to assess the athrombogenic potential of the vascular wall, namely, its antiaggregation activity. All smokers were divided into subgroups of “moderate” ( < 20 cigarettes per day) and “severe” (≥ 20 cigarettes per day) smokers. Results. In “severe” smokers, compared with apparently healthy non-smokers, increased values of Ht, BV, AT with both inductors, as well as EA were found. In “moderate” smokers, the levels of Ht, BV, and AT were lower not only than in “severe” smokers, but also in non-smokers. In patients with IS history a significant aggravation of almost all studied hemorheology and hemostasis biomarkers was revealed. The greatest differences were demonstrated between non-smokers (apparently healthy persons and IS patients) in fibrinogen level (2.43 g/l vs. 3.68 g/l) and adrenaline-induced AT (39.37% vs. 45.64%) respectively. Conclusions. It was demonstrated that smoking causes a significant aggravation of hemorheology and hemostasis biomarkers, and endothelial function, and these changes were more expressed in patients with IS history. The relatively more favorable haemostatic profile in “moderate” smokers needs to be confirmed in larger studies.

References 

1. Johnson C.O., Nguyen M., Roth G.A. et al. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2019;18(5):439– 58. DOI: 10.1016/S1474–4422(19)30034–1.
2. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neu- rol. 2021;20(10):795–820. DOI: 10.1016/S1474–4422(21)00252–0.
3. O’Donnell M.J., Chin S.L., Rangarajan S. et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388(10046):761–75. DOI: 10.1016/S0140– 6736(16)30506–2.
4. Luo J., Tang X., Li F. et al. Cigarette smoking and risk of diffe- rent pathologic types of stroke: a systematic review and dose- response meta-analysis. Front Neurol. 2022;12:772373. DOI: 10.3389/fneur.2021.772373.
5. Ramotowski B., Gurbel P.A., Tantry U., Budaj A. Smoking and car- diovascular diseases: paradox greater than expected? Pol Arch Intern Med. 2019;129(10):700–6. DOI: 10.20452/pamw.14931.
6. Tanashyan M.M. Hemostasis, hemorheology and athrombogenic activity of the vascular wall in angioneurology. Annaly kliniches- koj i eksperimental’noj nevrologii. 2007;1(2):29–33. (In Russ.).
7. Suslina Z.A., Tanashyan M.M., Domashenko M.A. et al. Endothelial dysfunction in ischemic disorders of cerebral circulation. Annaly klinicheskoj i eksperimental’noj nevrologii. 2008;2(1):4–11. (In Russ.).
8. Suslina Z.A., Tanashyan M.M., Ionova V.G. Ischemic stroke: blood, vascular wall, antithrombotic therapy. Moscow: Medicinskaya kniga, 2005. 248 pp. (In Russ.).
9. Yau J.W., Teoh H., Verma S. Endothelial cell control of throm- bosis. BMC Cardiovasc Disord. 2015;15:130. DOI: 10.1186/s12872– 015–0124-z.
10. Bykovskaya M.A., Raskurazhev A.A., Shabalina A.A. et al. Biomar- kers of vascular wall damage in patients with cerebrovascular diseases and type 2 diabetes mellitus. Tromboz, gemostaz i reologiya. 2021;(2):80–6. (In Russ.). DOI: 10.25555/THR.2021.2.0977.
11. Roitman E.V., Raskurazhev A.A., Lagoda O.V. et al. Endothelial dysfunction, platelet aggregation and blood rheological proper- ties in tobacco smokers. Tromboz, gemostaz i reologiya. 2022;(2):13– 22. DOI: 10.25555/THR.2022.2.1015.
12. Ghahremanfard F., Semnani V., Ghorbani R. et al. Effects of cigarette smoking on morphological features of platelets in healthy men. Saudi Med J. 2015;36(7):847–50. DOI: 10.15537/ smj.2015.7.11026.
13. Barua R.S., Ambrose J.A. Mechanisms of coronary thrombo- sis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol. 2013;33(7):1460–7. DOI: 10.1161/ATVBAHA.112.300154.
14. Alarabi A.B., Karim Z.A., Ramirez J.E.M. et al. Short-term expo- sure to waterpipe/hookah smoke triggers a hyperactive plate- let activation state increases the risk of thrombogenesis arterio- sclerosis thrombosis. Vasc Biol. 2020;40(2):335–49. DOI: 10.1161/ ATVBAHA.119.313435.
15. Doll R., Peto R., Boreham J., Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004:328(7455):1519. DOI: 10.1136/bmj.38142.554479.AE.
16. Bejot Y., Jacquin A., Daubail B. et al. Smoking status and seve- rity of ischemic stroke. A population-based study. Eur Neurol. 2014;71(1–2):59–64. DOI: 10.1159/000355021.
17. Ovbiagele B., Saver J.L. The smoking-thrombolysis paradox and acute ischemic stroke. Neurology. 2005;65(2):293–5. DOI: 10.1212/01.WNL.0000168163.72351.f3.
18. Barua R.S., Ambrose J.A. Mechanisms of coronary thrombosis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol. 2013;33(7):1460–7. DOI: 10.1161/ATVBAHA.112.300154.
19. Visseren F.L.J., Mach F., Smulders Y.M. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227–337. DOI: 10.1093/eurheartj/ehab484.
20. Choi S., Lee K., Park S.M. Combined associations of changes in noncombustible nicotine or tobacco product and combustible cigarette use habits with subsequent short-term cardiovascu- lar disease risk among South Korean Men: a nationwide cohort study. Circulation. 2021;144(19):1528–38. DOI: 10.1161/CIRCULA- TIONAHA.121.054967.
21. BerlowitzJ.B.,XieW.,HarlowA.F.etal.E-cigaretteuseandriskof cardiovascular disease: a longitudinal analysis of the PATH Study (2013–2019). Circulation. 2022;145(20):1557–9. DOI: 10.1161/CIRCU- LATIONAHA.121.057369.