Cardiovascular Morbidity Related to Cigarettes Smoked

A 24-hour ambulatory blood-pressure measurement in individuals with pre- and stage 1 hypertension reflects the effect of smoking burden better than a blood-pressure measurement taken in the clinic, researchers stated at the American Society of Hypertension (ASH) 29th Annual Scientific Meeting and Exposition.

The level of smoking burden correlates with 24-hour rate pressure product - a product of systolic blood pressure and heart rate that is a marker of cardiovascular mortality.

“The more cigarettes smoked, the higher the 24-hour rate pressure product,” explained lead author Vinay Gulati, MD, University of Connecticut Health Center, Farmington, Connecticut, speaking here on May 19

Dr. Gulati and colleagues sought to answer 2 questions: 1) What is the effect of smoking on sympathetic nervous-system activity? and 2) What is the association between smoking, 24-hour blood pressure, and catecholamine excretion rates?

These questions have been explored using blood-pressure measurements taken in the clinic, but not using ambulatory, 24-hour blood-pressure measurements. Reports have been conflicting regarding blood-pressure fluctuations in smokers. Nicotine may transiently raise blood pressure and heart rate, but it possesses a short half-life, and the effects of cotinine (its major metabolite) are opposite to those of nicotine.

The researchers evaluated 187 smokers (66% male, mean age 47 ± 10.7 years) who smoked over 10 cigarettes a day and had clinic blood-pressure measurements of 120 to 160 mmHg /80 to 100 mmHg. The mean body mass index of the subjects was 29.3 ± 5.7 kg/m2. Subjects smoked a mean average of 19.5 ± 7.8 cigarettes daily.

Prevention of Cardiovascular Morbidity Associated With Atrial Fibrillation Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. It is associated with substantial morbidity and mortality, owing to a significantly increased risk for stroke, thromboembolic events, heart failure (HF), impaired cognitive function, as well as an impaired quality of life. According to data from the Framingham study, the lifetime risk of developing AF is approximately 1 in 4 for white men and women aged 40 years and older. Although more common in individuals with underlying structural heart disease, the lifetime risk for AF remains high (1 in 6) even in individuals without prior congestive heart failure (CHF) or myocardial infarction (MI). The risk for AF increases with age; the vast majority of individuals with AF (approximately 70%) are between the ages of 65 and 85 years. Although the age-adjusted prevalence of AF is higher in men than in women, approximately 60% of the patients with AF who are older than 75 years of age are women, accounting for the greater longevity of women.

The prevalence and incidence of AF have increased considerably over the past 2 decades, especially in North America and Western Europe. According to a study that assessed community-based trends in AF incidence, the incidence of AF grew 12.1% between 1980 and 2000. Assuming the increased age-adjusted trends prevail, the authors estimated that the prevalence of AF in the United States could reach as high as 15.9 million by 2050.