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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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Review Article

Pathophysiologic Mechanisms of Tobacco Smoke Producing Atherosclerosis

Author(s): Lloyd W. Klein*

Volume 18, Issue 6, 2022

Published on: 22 June, 2022

Article ID: e110422203389 Pages: 8

DOI: 10.2174/1573403X18666220411113112

Price: $65

Abstract

Introduction: Despite the convincing epidemiologic association between smoking and vascular disease, the pathophysiologic mechanisms by which smoking initiates and contributes to the progression of atherosclerosis remain incompletely understood. A precise dose-dependent correlation has never been demonstrated, suggesting that the biological relationship is complex and influenced by individual genetic and possibly environmental factors. Although endothelial dysfunction and intimal damage appear to be central to atherogenesis, how tobacco products cause this effect has not been established. The purpose of this review is to describe the current state of knowledge of the main pathophysiologic pathways of how tobacco smoking abets atherosclerosis.

Constituents of Tobacco Smoke: Tobacco combustion produces a mixture of organic substances. derived from burning organic materials. The predominant gaseous phase constituents include carbon monoxide, acetaldehyde, formaldehyde, acrolein, and other carbonyls, as well as nicotine and tobacco-specific nitrosamines.

Potential Pathophysiologic Mechanisms: Smoking-induced changes in coronary vasomotor tone, platelet activation, and endothelial integrity are major components of both the development of atherosclerosis and its clinical presentation. Smoking may initiate and accelerate the progression of atherosclerosis by injuring the vascular intima. Other potential mechanisms include intimal damage and endothelial dysfunction, oxidative stress and injury, thrombosis, lipid abnormalities, and inflammation.

Conclusion: Smoking tobacco products contributes measurably to the incidence of acute vascular events and chronic disease. The causative compound, the exact mechanism of injury, and whether the atherogenic effect is modifiable are not known.

Keywords: Smoking, tobacco, pathogenesis, atherosclerosis, nicotine, vascular disease.

[1]
Benowitz NL. The role of nicotine in smoking-related cardiovascular disease. Prev Med 1997; 26(4): 412-7.
[http://dx.doi.org/10.1006/pmed.1997.0175] [PMID: 9245658]
[2]
Messner B, Bernhard D. Smoking and cardiovascular disease: Mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 2014; 34(3): 509-15.
[http://dx.doi.org/10.1161/ATVBAHA.113.300156] [PMID: 24554606]
[3]
Siasos G, Tsigkou V, Kokkou E, et al. Smoking and atherosclerosis: Mechanisms of disease and new therapeutic approaches. Curr Med Chem 2014; 21(34): 3936-48.
[http://dx.doi.org/10.2174/092986732134141015161539] [PMID: 25174928]
[4]
Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: Implications for nicotine replacement therapy. J Am Coll Cardiol 1997; 29(7): 1422-31.
[http://dx.doi.org/10.1016/S0735-1097(97)00079-X] [PMID: 9180099]
[5]
Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: An update. J Am Coll Cardiol 2004; 43(10): 1731-7.
[http://dx.doi.org/10.1016/j.jacc.2003.12.047] [PMID: 15145091]
[6]
United States Department of Health, Education and Welfare, Public Health Service Smoking and Health:. Report of the Advisory Committee to the Surgeon General of the Public Health Service (PHS Publication No 103). Washington, DC: Government Printing Office 1964.
[7]
Negri E, Franzosi MG, La Vecchia C, Santoro L, Nobili A, Tognoni G. Tar yield of cigarettes and risk of acute myocardial infarction. BMJ 1993; 306(6892): 1567-70.
[http://dx.doi.org/10.1136/bmj.306.6892.1567] [PMID: 8329914]
[8]
Bolinder G, Alfredsson L, Englund A, de Faire U. Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Am J Public Health 1994; 84(3): 399-404.
[http://dx.doi.org/10.2105/AJPH.84.3.399] [PMID: 8129055]
[9]
Glantz SA, Parmley WW. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation 1991; 83(1): 1-12.
[http://dx.doi.org/10.1161/01.CIR.83.1.1] [PMID: 1984876]
[10]
Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: An evaluation of the evidence. BMJ 1997; 315(7114): 973-80.
[http://dx.doi.org/10.1136/bmj.315.7114.973] [PMID: 9365294]
[11]
Piano MR, Benowitz NL, Fitzgerald GA, et al. Impact of smokeless tobacco products on cardiovascular disease: Implications for policy, prevention, and treatment: A policy statement from the American Heart Association. Circulation 2010; 122(15): 1520-44.
[http://dx.doi.org/10.1161/CIR.0b013e3181f432c3] [PMID: 20837898]
[12]
US Surgeon General Report, 1988: The Health Consequences of Smoking: Nicotine Addiction. U.S. Department of Health and Human Services
[13]
The chemical constituents in cigarettes and cigarette smoke: Potential for harm reduction. A Report to the New Zealand Ministry of Health 2000.
[14]
California Environmental Protection Agency (Cal/EPA). Health effects of exposure to environmental tobacco smoke Final report. 1997.
[15]
Klein LW. Systemic and Coronary Hemodynamic Effects of Tobacco Products on the Cardiovascular System and Potential Pathophysiologic Mechanisms. Cardiology 2021. Publish Ahead of Print
[http://dx.doi.org/10.1097/CRD.0000000000000395] [PMID: 34001689]
[16]
Schick S, Glantz S. Philip Morris toxicological experiments with fresh sidestream smoke: More toxic than mainstream smoke. Tob Control 2005; 14(6): 396-404.
[http://dx.doi.org/10.1136/tc.2005.011288] [PMID: 16319363]
[17]
Smith CJ, Fischer TH. Particulate and vapor phase constituents of cigarette mainstream smoke and risk of myocardial infarction. Atherosclerosis 2001; 158(2): 257-67.
[http://dx.doi.org/10.1016/S0021-9150(01)00570-6] [PMID: 11583703]
[18]
Cryer PE, Haymond MW, Santiago JV, Shah SD. Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med 1976; 295(11): 573-7.
[http://dx.doi.org/10.1056/NEJM197609092951101] [PMID: 950972]
[19]
West JW, Guzman SV, Bellett S. Cardiac effects of intracoronary arterial injections of nicotine. Circ Res 1958; 6(3): 389-95.
[http://dx.doi.org/10.1161/01.RES.6.3.389] [PMID: 13523823]
[20]
Czernin J, Waldherr C. Cigarette smoking and coronary blood flow. Prog Cardiovasc Dis 2003; 45(5): 395-404.
[http://dx.doi.org/10.1016/S0033-0620(03)80003-8] [PMID: 12704596]
[21]
Lee J, Cooke JP. The role of nicotine in the pathogenesis of atherosclerosis. Atherosclerosis 2011; 215(2): 281-3.
[http://dx.doi.org/10.1016/j.atherosclerosis.2011.01.003] [PMID: 21345436]
[22]
Michael Pittilo R. Cigarette smoking, endothelial injury and cardiovascular disease. Int J Exp Pathol 2000; 81(4): 219-30.
[http://dx.doi.org/10.1046/j.1365-2613.2000.00162.x] [PMID: 10971743]
[23]
Hamasaki H, Sato J, Masuda H, et al. Effect of nicotine on the intimal hyperplasia after endothelial removal of the rabbit carotid artery. Gen Pharmacol 1997; 28(5): 653-9.
[http://dx.doi.org/10.1016/S0306-3623(96)00369-2] [PMID: 9184797]
[24]
Davis JW, Shelton L, Eigenberg DA, Hignite CE, Watanabe IS. Effects of tobacco and non-tobacco cigarette smoking on endothelium and platelets. Clin Pharmacol Ther 1985; 37(5): 529-33.
[http://dx.doi.org/10.1038/clpt.1985.83] [PMID: 3987176]
[25]
Neunteufl T, Heher S, Kostner K, et al. Contribution of nicotine to acute endothelial dysfunction in long-term smokers. J Am Coll Cardiol 2002; 39(2): 251-6.
[http://dx.doi.org/10.1016/S0735-1097(01)01732-6] [PMID: 11788216]
[26]
Barua RS, Ambrose JA. Mechanisms of coronary thrombosis in cigarette smoke exposure. Arterioscler Thromb Vasc Biol 2013; 33(7): 1460-7.
[http://dx.doi.org/10.1161/ATVBAHA.112.300154] [PMID: 23685556]
[27]
Leone A. How and why chemicals from tobacco smoke can induce a rise in blood pressure. World J Pharmacol 2012; 1(1): 10-20.
[http://dx.doi.org/10.5497/wjp.v1.i1.10]
[28]
Klein LW, Ambrose J, Pichard A, Holt J, Gorlin R, Teichholz LE. Acute coronary hemodynamic response to cigarette smoking in patients with coronary artery disease. J Am Coll Cardiol 1984; 3(4): 879-86.
[http://dx.doi.org/10.1016/S0735-1097(84)80344-7] [PMID: 6707354]
[29]
Nicod P, Rehr R, Winniford MD, Campbell WB, Firth BG, Hillis LD. Acute systemic and coronary hemodynamic and serologic responses to cigarette smoking in long-term smokers with atherosclerotic coronary artery disease. J Am Coll Cardiol 1984; 4(5): 964-71.
[http://dx.doi.org/10.1016/S0735-1097(84)80058-3] [PMID: 6548482]
[30]
Winniford MD, Wheelan KR, Kremers MS, et al. Smoking-induced coronary vasoconstriction in patients with atherosclerotic coronary artery disease: Evidence for adrenergically mediated alterations in coronary artery tone. Circulation 1986; 73(4): 662-7.
[http://dx.doi.org/10.1161/01.CIR.73.4.662] [PMID: 3948369]
[31]
Martin JL, Wilson JR, Ferraro N, Laskey WK, Kleaveland JP, Hirshfeld JW Jr. Acute coronary vasoconstrictive effects of cigarette smoking in coronary heart disease. Am J Cardiol 1984; 54(1): 56-60.
[http://dx.doi.org/10.1016/0002-9149(84)90303-5] [PMID: 6741839]
[32]
Quillen JE, Rossen JD, Oskarsson HJ, Minor RL Jr, Lopez AG, Winniford MD. Acute effect of cigarette smoking on the coronary circulation: Constriction of epicardial and resistance vessels. J Am Coll Cardiol 1993; 22(3): 642-7.
[http://dx.doi.org/10.1016/0735-1097(93)90170-6] [PMID: 8354792]
[33]
Celermajer DS, Sorensen KE, Georgakopoulos D, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation 1993; 88(5 Pt 1): 2149-55.
[http://dx.doi.org/10.1161/01.CIR.88.5.2149] [PMID: 8222109]
[34]
Barua RS, Ambrose JA, Eales-Reynolds LJ, DeVoe MC, Zervas JG, Saha DC. Dysfunctional endothelial nitric oxide biosynthesis in healthy smokers with impaired endothelium-dependent vasodilatation. Circulation 2001; 104(16): 1905-10.
[http://dx.doi.org/10.1161/hc4101.097525] [PMID: 11602492]
[35]
Celermajer DS, Adams MR, Clarkson P, et al. Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults. N Engl J Med 1996; 334(3): 150-4.
[http://dx.doi.org/10.1056/NEJM199601183340303] [PMID: 8531969]
[36]
Klein LW, Pichard AD, Holt J, Smith H, Gorlin R, Teichholz LE. Effects of chronic tobacco smoking on the coronary circulation. J Am Coll Cardiol 1983; 1(2 Pt 1): 421-6.
[http://dx.doi.org/10.1016/S0735-1097(83)80069-2] [PMID: 6826953]
[37]
Zeiher AM, Schächinger V, Minners J. Long-term cigarette smoking impairs endothelium-dependent coronary arterial vasodilator function. Circulation 1995; 92(5): 1094-100.
[http://dx.doi.org/10.1161/01.CIR.92.5.1094] [PMID: 7648652]
[38]
Klein LW. Cigarette smoking, atherosclerosis and the coronary hemodynamic response: A unifying hypothesis. J Am Coll Cardiol 1984; 4(5): 972-4.
[http://dx.doi.org/10.1016/S0735-1097(84)80059-5] [PMID: 6386934]
[39]
Bolorunduro O, Cushman C, Kapoor D, et al. Comparison of coronary atherosclerotic plaque burden and composition of culprit lesions between cigarette smokers and non-smokers by in vivo virtual histology intravascular ultrasound. J Invasive Cardiol 2015; 27(8): 354-8.
[PMID: 25999135]
[40]
Gupta T, Kolte D, Khera S, et al. Smoker’s paradox in patients with st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Am Heart Assoc 2016; 5(4): e003370.
[http://dx.doi.org/10.1161/JAHA.116.003370] [PMID: 27107131]
[41]
Yadav M, Mintz GS, Généreux P, et al. The Smoker’s Paradox Revisited: A Patient-Level Pooled Analysis of 18 Randomized Controlled Trials. JACC Cardiovasc Interv 2019; 12(19): 1941-50.
[http://dx.doi.org/10.1016/j.jcin.2019.06.034] [PMID: 31521646]
[42]
Craig WY, Palomaki GE, Haddow JE. Cigarette smoking and serum lipid and lipoprotein concentrations: An analysis of published data. BMJ 1989; 298(6676): 784-8.
[http://dx.doi.org/10.1136/bmj.298.6676.784] [PMID: 2496857]
[43]
Freedman DS, Srinivasan SR, Shear CL, et al. Cigarette smoking initiation and longitudinal changes in serum lipids and lipoproteins in early adulthood: The Bogalusa Heart Study. Am J Epidemiol 1986; 124(2): 207-19.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a114379] [PMID: 3728437]
[44]
Nakamura K, Barzi F, Huxley R, et al. Does cigarette smoking exacerbate the effect of total cholesterol and high-density lipoprotein cholesterol on the risk of cardiovascular diseases? Heart 2009; 95(11): 909-16.
[http://dx.doi.org/10.1136/hrt.2008.147066] [PMID: 19196734]
[45]
Neufeld EJ, Mietus-Snyder M, Beiser AS, Baker AL, Newburger JW. Passive cigarette smoking and reduced HDL cholesterol levels in children with high-risk lipid profiles. Circulation 1997; 96(5): 1403-7.
[http://dx.doi.org/10.1161/01.CIR.96.5.1403] [PMID: 9315524]
[46]
Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH. Effects of smoking and smoking cessation on lipids and lipoproteins: Outcomes from a randomized clinical trial. Am Heart J 2011; 161(1): 145-51.
[http://dx.doi.org/10.1016/j.ahj.2010.09.023] [PMID: 21167347]
[47]
Maeda K, Noguchi Y, Fukui T. The effects of cessation from cigarette smoking on the lipid and lipoprotein profiles: A meta-analysis. Prev Med 2003; 37(4): 283-90.
[http://dx.doi.org/10.1016/S0091-7435(03)00110-5] [PMID: 14507483]
[48]
Garbin U, Fratta Pasini A, Stranieri C, et al. Cigarette smoking blocks the protective expression of Nrf2/ARE pathway in peripheral mononuclear cells of young heavy smokers favouring inflammation. PLoS One 2009; 4(12): e8225.
[http://dx.doi.org/10.1371/journal.pone.0008225] [PMID: 20011043]
[49]
Morrow JD, Frei B, Longmire AW, et al. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. N Engl J Med 1995; 332(18): 1198-203.
[http://dx.doi.org/10.1056/NEJM199505043321804] [PMID: 7700313]
[50]
Pryor WA, Stone K. Oxidants in cigarette smoke. Radicals, hydrogen peroxide, peroxynitrate, and peroxynitrite. Ann N Y Acad Sci 1993; 686(1 Tobacco Smoki): 12-27.
[http://dx.doi.org/10.1111/j.1749-6632.1993.tb39148.x] [PMID: 8512242]
[51]
Yamaguchi Y, Matsuno S, Kagota S, Haginaka J, Kunitomo M. Peroxynitrite-mediated oxidative modification of low-density lipoprotein by aqueous extracts of cigarette smoke and the preventive effect of fluvastatin. Atherosclerosis 2004; 172(2): 259-65.
[http://dx.doi.org/10.1016/j.atherosclerosis.2003.09.030] [PMID: 15019535]
[52]
Klein LW, Gopalakrishnan M. The correlation between cigarette smoking and other risk factors with coronary stenosis composition. J Invasive Cardiol 2015; 27(8): 359-61.
[PMID: 26232012]
[53]
Kaufmann PA, Gnecchi-Ruscone T, di Terlizzi M, Schäfers KP, Lüscher TF, Camici PG. Coronary heart disease in smokers: Vitamin C restores coronary microcirculatory function. Circulation 2000; 102(11): 1233-8.
[http://dx.doi.org/10.1161/01.CIR.102.11.1233] [PMID: 10982536]
[54]
Barua RS, Ambrose JA, Srivastava S, DeVoe MC, Eales-Reynolds LJ. Reactive oxygen species are involved in smoking-induced dysfunction of nitric oxide biosynthesis and upregulation of endothelial nitric oxide synthase: An in vitro demonstration in human coronary artery endothelial cells. Circulation 2003; 107(18): 2342-7.
[http://dx.doi.org/10.1161/01.CIR.0000066691.52789.BE] [PMID: 12707237]
[55]
Bernhard D, Wang XL. Smoking, oxidative stress and cardiovascular diseases--do anti-oxidative therapies fail? Curr Med Chem 2007; 14(16): 1703-12.
[http://dx.doi.org/10.2174/092986707781058959] [PMID: 17627508]
[56]
Abu-Hayyeh S, Sian M, Jones KG, Manuel A, Powell JT. Cadmium accumulation in aortas of smokers. Arterioscler Thromb Vasc Biol 2001; 21(5): 863-7.
[http://dx.doi.org/10.1161/01.ATV.21.5.863] [PMID: 11348888]
[57]
Jaimes EA, DeMaster EG, Tian RX, Raij L. Stable compounds of cigarette smoke induce endothelial superoxide anion production via NADPH oxidase activation. Arterioscler Thromb Vasc Biol 2004; 24(6): 1031-6.
[http://dx.doi.org/10.1161/01.ATV.0000127083.88549.58] [PMID: 15059808]
[58]
Kojda G, Harrison D. Interactions between NO and reactive oxygen species: Pathophysiological importance in atherosclerosis, hypertension, diabetes and heart failure. Cardiovasc Res 1999; 43(3): 562-71.
[http://dx.doi.org/10.1016/S0008-6363(99)00169-8] [PMID: 10690328]
[59]
Nedeljkovic ZS, Gokce N, Loscalzo J. Mechanisms of oxidative stress and vascular dysfunction. Postgrad Med J 2003; 79(930): 195-9.
[http://dx.doi.org/10.1136/pmj.79.930.195] [PMID: 12743334]
[60]
Heitzer T, Brockhoff C, Mayer B, et al. Tetrahydrobiopterin improves endothelium-dependent vasodilation in chronic smokers: Evidence for a dysfunctional nitric oxide synthase. Circ Res 2000; 86(2): E36-41.
[http://dx.doi.org/10.1161/01.RES.86.2.e36] [PMID: 10666424]
[61]
Kayyali US, Budhiraja R, Pennella CM, et al. Upregulation of xanthine oxidase by tobacco smoke condensate in pulmonary endothelial cells. Toxicol Appl Pharmacol 2003; 188(1): 59-68.
[http://dx.doi.org/10.1016/S0041-008X(02)00076-5] [PMID: 12668123]
[62]
Guthikonda S, Sinkey C, Barenz T, Haynes WG. Xanthine oxidase inhibition reverses endothelial dysfunction in heavy smokers. Circulation 2003; 107(3): 416-21.
[http://dx.doi.org/10.1161/01.CIR.0000046448.26751.58] [PMID: 12551865]
[63]
McEvoy JW, Blaha MJ, DeFilippis AP, et al. Cigarette smoking and cardiovascular events: Role of inflammation and subclinical atherosclerosis from the MultiEthnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2015; 35(3): 700-9.
[http://dx.doi.org/10.1161/ATVBAHA.114.304562] [PMID: 25573855]
[64]
Shimada S, Hasegawa K, Wada H, et al. High blood viscosity is closely associated with cigarette smoking and markedly reduced by smoking cessation. Circ J 2011; 75(1): 185-9.
[http://dx.doi.org/10.1253/circj.CJ-10-0335] [PMID: 21071876]

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