STATE-OF-THE-ART PAPER
The pathophysiology of cigarette smoking and cardiovascular disease
An update
John A. Ambrose, MD, FACC*,* and
Rajat S. Barua, MD, PhD
* Comprehensive Cardiovascular Center, Saint Vincent Catholic Medical Centers of New York, New York Medical College, New York, New York, USA
Department of Medicine, the Bronx Veteran Affairs Medical Center, Mount Sinai School of Medicine, New York, New York, USA
Manuscript received September 24, 2003;
revised manuscript received December 18, 2003,
accepted December 23, 2003.
* Reprint requests and correspondence: Dr. John A. Ambrose, The Comprehensive Cardiovascular Center, Saint Vincent Catholic Medical Centers of New York, 170 West 12th Street, New York, New York 10011, USA.
jamambrose{at}yahoo.com
Cigarette smoking (CS) continues to be a major health hazard, and it contributes significantly to cardiovascular morbidity and mortality. Cigarette smoking impacts all phases of atherosclerosis from endothelial dysfunction to acute clinical events, the latter being largely thrombotic. Both active and passive (environmental) cigarette smoke exposure predispose to cardiovascular events. Whether there is a distinct direct dose-dependent correlation between cigarette smoke exposure and risk is debatable, as some recent experimental clinical studies have shown a non-linear relation to cigarette smoke exposure. The exact toxic components of cigarette smoke and the mechanisms involved in CS-related cardiovascular dysfunction are largely unknown, but CS increases inflammation, thrombosis, and oxidation of low-density lipoprotein cholesterol. Recent experimental and clinical data support the hypothesis that cigarette smoke exposure increases oxidative stress as a potential mechanism for initiating cardiovascular dysfunction.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | CO | = carbon monoxide | | CS | = cigarette smoking | | CSE | = cigarette smoke extract | | EDV | = endothelium-dependent vasodilation | | HUVECs | = human umbilical vein endothelial cells | | LDL | = low-density lipoprotein | | MI | = myocardial infarction | | NO | = nitric oxide | | TF | = tissue factor | | TFPI-1 | = tissue factor pathway inhibitor-1 |
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