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Abstract
purpose: Cigarette smoking is a major coronary risk factor. Acetylcholine dilates coronary
arteries in normal subjects, but acetylcholine-induced coronary constriction has been
reported in patients with normal coronary arteriographic findings and other risk factors
for coronary artery disease. The purpose of the present study was to evaluate the
epicardial coronary artery response to acetylcholine in young, heavy smokers.
subjects and methods: Responses to stepwise infusion of acetylcholine (10–8M, 10–7M,10–6M, and 10–5M) into the left coronary artery were studied in five young, heavy smokers and in
five age-matched nonsmokers. All subjects were normotensive and had normal left ventricular
function and coronary arteriographic findings. Levels of serum cholesterol, triglycerides,
and low-density lipoprotein levels were within normal ranges. Vessel dimensions were
measured on four different segments in each subject, with quantitative digital-substracted
arteriography.
results: In smokers, no change was produced at the 10–8M and 10–7M concentrations of acetylcholine, but progressive diameter reduction was observed
at 10–6M and 10–5M acetylcholine (–26.6% ± 13.6%, p <0.001;–42.2% ± 9.5%, p <0.001, respectively).
In nonsmokers, a progressive diameter dilation was produced from 10–8M to 10–6M acetylcholine (+5.3% ± 3.6%, p <0.001; +12.4% ± 6.5%, p <0.001; +15.9% ± 6.9%, p
<0.001, respectively), and no change was observed at 10–5M acetylcholine. In the two groups, all segments dilated after infusion of intracoronary
isosorbide dinitrate.
conclusion: The abnormal coronary vasoconstriction induced by acetylcholine in young, heavy smokers
with angiographically normal coronary arteries suggests an endothelial vasodilator
dysfunction. This mechanism may contribute to the pathogenesis of coronary artery
disease in cigarette smokers.
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References
- Cigarette smoking and coronary heart disease.in: Combined experience of the Albany and Framingham Studies. 5th ed. N Engl J Med. 266. 1962: 796-801
- Update on the role of cigarette smoking in coronary heart disease.Am Heart J. 1981; 101: 319-328
- The pathogenesis of atherosclerosis: an update.N Engl J Med. 1986; 314: 488-500
- Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death.N Engl J Med. 1984; 310: 1137-1140
- Smoking-induced coronary vasoconstriction in patients with atherosclerotic coronary artery disease: evidence for adrenergically mediated alterations in coronary artery tone.Circulation. 1986; 73: 662-667
- Platelet, endothelium, and vasospasm.Circulation. 1985; 72: 728-734
- The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.Nature. 1980; 288: 373-376
- Regulatory functions of the vascular endothelium.N Engl J Med. 1990; 323: 27-36
- Role of endothelium in responses of vascular smooth muscle.Circ Res. 1983; 53: 558-573
- Role of the endothelium in the control of vascular smooth muscle function.J Physiol (Paris). 1983; 78: 681-686
- Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries.N Engl J Med. 1986; 315: 1046-1051
- Atherosclerosis impairs flow-mediated dilation of coronary arteries in humans.Circulation. 1989; 80: 458-465
- Endothelial function in human coronary arteries in vivo.in: Focus on hypercholesterolemia. 5th ed. Hypertension. 18. 1991: II-90ĪI-99 (Suppl II)
- Abnormal endotheliumdependent coronary vasomotion in hypertensive patients.J Am Coll Cardiol. 1992; 19: 809-815
- Effects of cigarette smoke on rat thoracic aorta.Artery. 1980; 7: 56-72
- Effects of chronic oral consumption of nicotine on the rabbit aortic endothelium.Am J Pathol. 1981; 2: 229-238
- Intimal ultrastructure of human umbilical arteries.in: Observations on arteries from newborn children of smoking and non-smoking mothers. 5th ed. Circ Res. 36. 1975: 579-589
- Measurements of coronary sinus blood flow by continuous thermodilution in man.Circulation. 1971; 44: 181-195
- Effects of chronic tobacco smoking on the coronary circulation.J Am Coll Cardiol. 1983; 1: 421-426
- Usefulness and limitations of radiographic methods for determining left ventricular volume.Am J Cardiol. 1966; 18: 10-24
- A method for determining left ventricular mass in man.Circulation. 1964; 29: 666-671
- Local coronary supersensitivity to diverse vasoconstrictive stimuli in patients with variant angina.Circulation. 1986; 74: 1255-1265
- Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor.Nature. 1987; 327: 524-526
- Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults.Atherosclerosis. 1989; 9: I-19-II-32
- Coronary vasomotor response to acetylcholine relates to risk factors for coronary artery disease.Circulation. 1990; 81: 491-497
- Direct vasoconstriction and endothelium vasodilation.in: Mechanisms of acetylcholine effects on coronary flow and arterial diameter in patients with nonstenotic coronary arteries. 5th ed. Circulation. 79. 1989: 1043-1051
- Dual effects of acetylcholine on angiographically normal human coronary arteries in vivo.Circulation. 1987; 76 ([abstract]): IV-238
- Responses of angiographically normal human coronary arteries to intracoronary injection of acetylcholine by age and segment.in: Possible role of early coronary atherosclerosis. 5th ed. Circulation. 81. 1990: 482-490
- Effects of tobacco and non-tobacco cigarette smoking on endothelium and platelets.Clin Pharmacol Ther. 1985; 37: 529-533
- Indomethacin improves the impaired endothelium-dependent relaxations in small mesenteric arteries of the spontaneously hypertensive rat.Am J Hypertens. 1990; 3: 55-58
- Relation between tobacco use and urinary excretion of thromboxane A2 and prostacyclin metabolites in young men.Circulation. 1991; 83: 1698-1704
- Biochemical evidence of a chronic abnormality in platelet and vascular function in healthy individuals who smoke cigarettes.Circulation. 1987; 76: 6-14
- The anti-aggregating properties of vascular endothelium: interactions between prostacyclin and nitric oxide.Br J Pharmacol. 1987; 92: 639-646
- Platelet aggregability in smoking and non-smoking subjects.Clin Physiol. 1983; 3: 565-571
- Platelet survival and the development of coronary artery disease in the young adult: effects of cigarette smoking, strong family history and medical therapy.Circulation. 1981; 63: 546-551
- Acute coronary hemodynamic response to cigarette smoking in patients with coronary artery disease.J Am Coll Cardiol. 1984; 3: 879-886
- 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: 964-971
- Effects of intracoronary injection of acetylcholine on coronary arterial diameter.Am J Cardiol. 1986; 57: 984-989
Article info
Publication history
Accepted:
December 2,
1992
Received:
August 5,
1992
Identification
Copyright
© 1993 Published by Elsevier Inc.
