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CLINICAL STUDY: ENDOTHELIAL FUNCTION

The impact of heavy passive smoking on arterial endothelial function in modernized Chinese

Kam S. Woo, MD, FRACP, FACC^*, Ping Chook, MD^*, Hok C. Leong, MD, Xin S. Huang, MD and David S. Celermajer, PhD, FRACP

^* Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
Department of Medicine, Kiang Wu Hospital, Macau, People's Republic of China
Department of Medicine, University of Sydney, Sydney, Australia

Manuscript received December 30, 1999; revised manuscript received March 30, 2000, accepted June 2, 2000.

Reprint requests and correspondence: Prof. K. S. Woo, c/o Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, People’s Republic of China
kamsangwoo{at}cuhk.edu.hk

OBJECTIVES

The study evaluated whether heavy exposure to environmental tobacco smoke (passive smoking) might damage arterial function in modernized Chinese.

BACKGROUND

Heavy passive smoking is associated with arterial endothelial dysfunction in Caucasian, but not rural Chinese, subjects.

METHODS

We studied 20 young (mean age 36.6 ± 7.0 years) nonsmoking asymptomatic casino workers (9 men) in Macau who were exposed to environmental tobacco smoke for over 8 h/day for at least two years and 20 normal subjects (control subjects). These two groups were carefully matched for age, gender, body mass index (BMI), blood pressure, vessel diameter, cholesterol and glucose levels. Brachial artery diameter was measured by high-resolution B-mode ultrasound at rest, after flow increase (causing flow-mediated endothelium-dependent dilation) and after sublingual nitroglycerin (an endothelium-independent dilator).

RESULTS

Flow-mediated dilation (mean ± SD% of diameter changes) was significantly lower in passive smokers (6.6 ± 3.4%) compared with the controls (10.6 ± 2.3%) (p < 0.0001). Nitroglycerin-induced dilation of the two groups were similar. Upon multivariate analysis, passive smoking exposure was the strongest independent predictor (ß = –0.59; p = 0.0001) for impaired flow-mediated endothelium-dependent dilation (model R² = 0.75, F value = 6.1, p = 0.0001).

CONCLUSIONS

In modernized Chinese, as in Caucasians, exposure to heavy environmental tobacco smoke causes arterial endothelial dysfunction, a key early event in atherosclerosis. This may have serious implications for cardiovascular health in China, currently in a process of rapid modernization.

Abbreviations and Acronyms   BMI = body mass index   BP = blood pressure   FMD = flow-mediated dilation   HC = total plasma fasting homocyst(e)ine   HDL-C = high-density lipoprotein cholesterol   LDL-C = low-density lipoprotein cholesterol   NO = nitric oxide   NTG = nitroglycerin-induced dilation   TC = total cholesterol   TG = triglyceride

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