CLINICAL STUDY: ENDOTHELIAL FUNCTION
Contribution of nicotine to acute endothelial dysfunction in long-term smokers
Thomas Neunteufl, MD*,*,
Sandra Heher, MD*,
Karam Kostner, MD*,
Goran Mitulovic, PhD ,
Stephan Lehr ,
Gholamali Khoschsorur, PhD ,
Rainer W. Schmid, PhD,
Gerald Maurer, MD, FACC* and
Thomas Stefenelli, MD, FACC*
* Department of Cardiology, University of Vienna, Vienna, Austria
Clinical Chemistry, University of Vienna, Vienna, Austria
Institute for Medical Statistics, University of Vienna, Vienna, Austria
Institute of Biochemistry, University of Graz, Graz, Austria
Manuscript received July 19, 2000;
revised manuscript received July 24, 2001,
accepted October 17, 2001.
* Reprint requests and correspondence: Dr. Thomas Neunteufl, Department of Cardiology, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
thomas.neunteufl{at}univie.ac.at
OBJECTIVES: The aim of this study was to determine whether nicotine, a constituent of cigarette smoke, contributes to acute endothelial dysfunction after smoking one cigarette.
BACKGROUND: Animal studies suggest that nicotine might cause an impairment of endothelium-dependent vasodilation via an increase in oxidative stress.
METHODS: Sixteen healthy smokers were entered into a randomized, observer-blinded crossover study comparing the effects of nicotine nasal spray (1-mg nicotine) and cigarette smoke (1-mg nicotine, 12 mg tar) on vascular reactivity in the brachial artery. Using high-resolution ultrasound, flow-mediated dilation (FMD) and endothelium-independent, nitroglycerin-induced dilation were assessed at baseline and 20 min after the administration of nicotine (spray or cigarette).
RESULTS: In response to similar increases in nicotine serum levels, FMD values declined from 10.2 ± 4.4% to 6.7 ± 4.0% after the spray (mean difference: –3.6 ± 2.0%, 95% confidence interval: –4.6; –2.5, p < 0.0001) and from 9.4 ± 3.8% to 4.3 ± 2.8% after the cigarette (–5.1 ± 2.6%, –6.5; –3.7, p < 0.0001). Nitroglycerin-induced dilation remained similar within both periods. Performing a period effect analysis of variance, a significant influence on FMD was found for the mode of administration (p = 0.017) and the baseline value (p = 0.021). The effect on FMD was more pronounced after the cigarette than after the spray (estimated average effect difference: 1.9% FMD). Oxidation parameters did not increase significantly after nicotine spray or tobacco exposure.
CONCLUSIONS: These results demonstrate that nicotine alone causes acute endothelial dysfunction, although to a lesser extent than smoking a cigarette of the same nicotine yield. However, the precise mechanisms by which nicotine leads to this altered vascular reactivity remain unclear.
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