Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease?
ABSTRACT Smoking, both active and passive, is an established vascular risk factor. The present narrative review considers the effects of different forms of smoking (i.e. cannabis, cigar, pipe, smokeless tobacco and cigarette) on cardiovascular risk. Furthermore, the impact of smoking on several vascular risk factors [e.g. hypertension, diabetes mellitus (DM), dyslipidaemia and haemostasis] and on vascular diseases such as coronary heart disease (CHD), peripheral arterial disease (PAD), abdominal aortic aneurysms (AAA) and carotid arterial disease, is discussed. The adverse effects of all forms of smoking and the interactions between smoking and established vascular risk factors highlight the importance of smoking cessation in high-risk patients in terms of both primary and secondary vascular disease prevention. Healthcare providers should discourage people (especially the young) from becoming smokers, strongly encourage all vascular patients to stop smoking and support those who decide to quit by pharmaceutical and psychological interventions. In high-risk populations such as patients with CHD, DM and/or PAD, smoking cessation should always be a part of a multifactorial treatment to reduce vascular risk.
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ABSTRACT: Study Design. Retrospective study.Objective. To study the impact of smoking status on postoperative complications and pseudoarthrosis in adult patients undergoing posterolateral fusion (PLF) of the lumbar spine.Summary of Background Data. Results of studies analyzing the impact of smoking on complication and pseudoarthrosis rates following spine surgery are conflicting.Methods. A retrospective medical record review was performed to identify all adult patients who underwent single and two-level instrumented PLF without interbody devices for degenerative spine disease in a 21-year period at a single institution. Patients were divided into smokers and non-smokers. The main outcome variables were development of at least one post-operative complication and development of pseudoarthrosis.Results. A total of 281 patients underwent single or two-level PLF in the 21-year period. Of these, 231 (82.21%) patients were non- smokers and 50 (17.9%) smokers. For patients undergoing single-level PLF, complication rates in non-smokers (3.57%) vs. smokers (7.69%) were not significantly different (P = 0.353); pseudoarthrosis in non-smokers occurred in 9.82% of cases compared to 7.69% in the smoker's group (P = 0.738). Non-smokers undergoing two-level PLF had complication rates of 6.72%, compared to 4.17% in smokers (P = 0.638), but pseudoarthrosis rates were significantly higher in the smoker's group compared to non-smokers (29.17% vs. 10.92%; P = 0.019). Patients were followed-up for an average of 53.5 months.Conclusion. The findings in the present study suggest that smoking has a significant impact on pseudoarthrosis rates following two-level PLF of the lumbar spine, but not necessarily on single-level PLF.Spine 07/2014; 39(21). DOI:10.1097/BRS.0000000000000527 · 2.45 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the influence of atherogenic risk factors on hearing thresholds. In a cross-sectional study we analyzed data from a Danish survey in 2009-2010 on physical and psychological working conditions. The study included 576 white- and blue-collar workers from children's day care units, financial services and 10 manufacturing trades. Associations between atherogenic risk factors (blood lipids, glycosylated hemoglobin, smoking habits, body mass index (BMI), and ambulatory blood pressure) and hearing thresholds were analyzed using multiple linear regression models. Adjusted results suggested associations between smoking, high BMI and triglyceride level and low high-density lipoprotein level and increased low-frequency hearing thresholds (average of pure-tone hearing thresholds at 0.25, 0.5 and 1 kHz). Furthermore, an increasing load of atherogenic risk factors seemed associated with increased low-frequency hearing thresholds, but only at a borderline level of statistical significance. Associations were generally strongest with hearing levels of the worst hearing ear. We found no statistically significant associations between atherogenic risk factors and high-frequency hearing thresholds (average of pure-tone hearing thresholds at 4, 6 and 8 kHz). © 2014 S. Karger AG, Basel.Audiology and Neurotology 10/2014; 19(5):310-318. DOI:10.1159/000365439 · 2.32 Impact Factor
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ABSTRACT: Abstract Objective: To evaluate the epidemiology and predictors of asymptomatic peripheral artery disease (PAD) in patients with a single previous coronary or cerebrovascular event in the Arabian Gulf. Methods: This was a cross-sectional, multicenter, observational survey in consecutive patients (≥18 years) with documented previous coronary and/or cerebrovascular atherothrombotic event in the United Arab Emirates (UAE), Kuwait and Qatar (64 centers), from October 2008 to December 2010. PAD was defined as an ankle brachial index <0.9 in at least one leg. Results: The overall mean age of the cohort (n=2,110) was 54±11 years with only 14% being female (n=303). The prevalence of asymptomatic PAD was 13.7%, with the highest prevalence seen in Kuwait (16.3%) and the UAE (14.7%) and lowest in Qatar (5.3%). There were significant differences in the prevalence of asymptomatic PAD among the ethnic groups (p<0.001); highest among the local Arabs and Caucasians at 19% and lowest among South East Asians (6%). The multivariate logistic model demonstrated that the most significant predictors of PAD were old age (adjusted odds ratio (OR), 1.04; 95% CI: 1.02-1.05; p<0.001), female gender (OR, 1.56; 95% CI: 1.06-2.29; p=0.024), ethnicity (OR, 0.39; 95% CI: 0.19-0.79; p=0.009), smoking (OR, 1.70; 95% CI: 1.22-2.37: p=0.002) and diabetes mellitus (OR, 1.49; 95% CI: 1.14-1.94; p=0.004). Conclusions: PAD is prevalent in the Arabian Gulf and was more likely to be associated with old age, females, ethnicity, smokers and those with diabetes mellitus.Current Medical Research and Opinion 05/2014; 30(9). DOI:10.1185/03007995.2014.921609 · 2.37 Impact Factor