Unfavorable Effect of Smoking on the Elastic Properties of the Human Aorta

Stefanadis, Christodoulos; Tsiamis, Eleftherios; Vlachopoulos, Charalambos; Stratos, Costas; Toutouzas, Konstantinos; Pitsavos, Christos; Marakas, Stelios; Boudoulas, Harisios; Toutouzas, Pavlos

doi:10.1161/01.cir.95.1.31

Cited by 182 publications

(135 citation statements)

References 38 publications

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“…Increased AIx and arterial stiffness are associated with several cardiovascular risk factors, 12 including age, smoking, 23 hypertension, diabetes mellitus, and hypercholesterolemia. Some of them (smoking and total and LDL cholesterol) were distributed equally between CAD and non-CAD patients in our study population; the others (age, height, HDL cholesterol, and presence of hypertension) were accounted for in multivariate analysis, resulting in even higher ORs.…”

Section: Discussionmentioning

confidence: 99%

Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease

Weber

Auer²,

O’Rourke³

et al. 2004

Circulation

989

673

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Background-Increased arterial stiffness, determined invasively, has been shown to predict a higher risk of coronary atherosclerosis. However, invasive techniques are of limited value for screening and risk stratification in larger patient groups. Methods and Results-We prospectively enrolled 465 consecutive, symptomatic men undergoing coronary angiography for the assessment of suspected coronary artery disease. Arterial stiffness and wave reflections were quantified noninvasively using applanation tonometry of the radial artery with a validated transfer function to generate the corresponding ascending aortic pressure waveform. Augmented pressure (AP) was defined as the difference between the second and the first systolic peak, and augmentation index (AIx) was AP expressed as a percentage of the pulse pressure.In univariate analysis, a higher AIx was associated with an increased risk for coronary artery disease (OR, 4.06 for the difference between the first and the fourth quartile [1.72 to 9.57; PϽ0.01]). In multivariate analysis, after controlling for age, height, presence of hypertension, HDL cholesterol, and medications, the association with coronary artery disease risk remained significant (OR, 6.91; PϽ0.05). The results were exclusively driven by an increase in risk with premature vessel stiffening in the younger patient group (up to 60 years of age), with an unadjusted OR between AIx quartiles I and IV of 8.25 (PϽ0.01) and a multiple-adjusted OR between these quartiles of 16.81 (PϽ0.05). Conclusions-AIx and AP, noninvasively determined manifestations of arterial stiffening and increased wave reflections, are strong, independent risk markers for premature coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease

Weber

Auer²,

O’Rourke³

et al. 2004

Circulation

989

673

View full text Add to dashboard Cite

show abstract

“…A greater AIx is an indicator of the additional load imposed on the left ventricle by the reflected wave and is correlated with left ventricular mass [12,13]. AIx has also been found to correlate with CHD risk factors [14][15][16][17][18], coronary atherosclerosis [19,20], and cardiovascular outcomes [21,22]. AIx, determined non-invasively, has been shown to be associated with angiographic coronary artery disease in men <60 years [20] and to be predictive of mortality in patients with end-stage renal disease even after adjustment for pulse wave velocity [21].…”

Section: Introductionmentioning

confidence: 99%

Aortic augmentation index is associated with the ankle-brachial index: A community-based study

Khaleghi

Kullo

2007

Atherosclerosis

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Background-Increased arterial stiffness has been associated with greater risk of cardiovascular events. We investigated whether aortic augmentation index (AIx), a measure of arterial stiffness and wave reflection, was associated with the ankle-brachial index (ABI), a measure of peripheral arterial disease (PAD).Method-AIx and ABI were measured in a community-based sample of 475 adults without prior history of heart attack or stroke (mean age 59.3 years, 46.5% men). Radial artery pulse waveforms were obtained by applanation tonometry and an ascending aortic pressure waveform derived by a transfer function. AIx is the difference between the first and second systolic peak of the ascending aortic pressure waveform indexed to the central pulse pressure. ABI was measured using a standard protocol, and subjects with non-compressible vessels (ABI >1.5) were excluded from the analyses. Multivariable linear and logistic generalized estimating equations (GEE) analyses were used to assess whether AIx was associated with ABI and ABI <1.00 respectively, independent of conventional risk factors.Results-Mean (± SD) values were: AIx, 29.3±11.6 %; ABI, 1.12±0.13; 59 (12.4%) participants had an ABI <1.00. Variables associated with a lower ABI (and ABI <1.00) included older age, shorter height, female sex, higher total cholesterol, hypertension medication use, history of smoking, and higher AIx. After adjustment for mean arterial pressure and the above variables, higher AIx remained associated with a lower ABI (P=0.015) and ABI <1.00 (P=0.002). A significant interaction (P=0.007) was present between AIx and age in the prediction of ABI; the (inverse) association of AIx with ABI was stronger in older subjects (>65 years).Conclusion-AIx, a measure of arterial stiffness and wave reflection, was independently associated with a lower ABI in asymptomatic subjects from the community, and this association was modified by age.

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“…Specifically, increased stiffness is associated with aging (14), atherosclerosis (6), and heart failure (27). It is also associated with various risk factors including hypertension (7), diabetes (42), hyperlipidemia (33), and smoking (43). Furthermore, arterial stiffness has also been shown to be an independent risk factor for cardiovascular events such as primary coronary events (3).…”

mentioning

confidence: 99%

Right coronary artery becomes stiffer with increase in elastin and collagen in right ventricular hypertrophy

Garcia

Kassab²

2009

Journal of Applied Physiology

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Garcia M, Kassab GS. Right coronary artery becomes stiffer with increase in elastin and collagen in right ventricular hypertrophy. J Appl Physiol 106: 1338 -1346, 2009. First published January 29, 2009 doi:10.1152/japplphysiol.90592.2008.-Changes in blood flow influence the structure, function, mechanical properties, and remodeling of arteries. The objective of the present study was to investigate the role of increased blood flow on the biaxial incremental elastic moduli of the porcine right coronary artery (RCA) and to determine the microstructural basis for the changes in moduli. We hypothesized that an increase in RCA flow will lead to increased stiffness in conjunction with remodeling of elastin and collagen in the vessel wall. The control and experimental groups consisted of five RCA vessels each. The RCA of the experimental group was exposed to 4 wk of flow-overload in right ventricular hypertrophy induced by pulmonary artery banding. Stress-strain relationships were determined and the incremental elastic moduli were derived in the circumferential, axial, and cross directions. The results show a significant increase in the elastic moduli in the circumferential (262.7 Ϯ 15.7 vs. 120.2 Ϯ 12.4 kPa; P Ͻ 0.001), axial (177.8 Ϯ 25.5 vs. 100.3 Ϯ 11.9 kPa; P ϭ 0.025), and cross directions (104.8 Ϯ 8.2 vs. 68.2 Ϯ 8.6 kPa; P ϭ 0.016) of the experimental RCA compared with controls. Multiphoton microscopy was used to assess the changes in elastin and collagen content in the media and adventitia of the vessel wall. We found a significant increase in elastin and collagen area fraction particularly in the adventitial layer. These data suggest stiffening of the vessel wall as a result of increased elastin and more predominantly collagen. stress; strain; wall shear stress; constitutive equation BLOOD VESSELS ARE subjected to the mechanical loading of blood pressure and blood flow throughout the cardiac cycle. The vessels undergo structural and mechanical adaptations in response to changes in the local hemodynamic conditions. For example, changes in blood flow cause changes in fluid wall shear stress (WSS; the tractive frictional force exerted by flowing blood on the inner layer of the vessel wall) by eliciting a wide range of biochemical and physiological responses in experimental (46) and clinical studies (16,22). Studies have demonstrated that a sudden increase in blood flow initiates an enlargement of the arterial lumen that progresses for months as the WSS tends to a homeostatic or normal level (23,25). A gradual increase in blood flow has been reported by several groups to result in outward hypertrophic remodeling of resistance (4,41,44,45,47) and conductive arteries (25,36,39). The flow-induced remodeling may be an attempt to maintain mechanical homeostasis (24,25). When blood flow is elevated in a vessel, the endothelium responds to restore WSS toward homeostatic levels by changing vascular tone, increasing the lumen diameter (44), and potentially altering the function and mechanical properties of the vessel wall. ...

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Unfavorable Effect of Smoking on the Elastic Properties of the Human Aorta

Abstract: Smoking is associated with an acute deterioration of aortic elastic properties. This effect of smoking may contribute to the unfavorable consequences of smoking on the cardiovascular system.

Cited by 182 publications

References 38 publications

Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease

Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease

Aortic augmentation index is associated with the ankle-brachial index: A community-based study

Right coronary artery becomes stiffer with increase in elastin and collagen in right ventricular hypertrophy

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