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J Am Coll Cardiol, 2004; 43:1731-1737, doi:10.1016/j.jacc.2003.12.047
© 2004 by the American College of Cardiology Foundation
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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{dagger}

* Comprehensive Cardiovascular Center, Saint Vincent Catholic Medical Centers of New York, New York Medical College, New York, New York, USA
{dagger} 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.

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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