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CORK Bibliography: Drugs and the Cardiovascular System

95 citations. March 2008 to present

Prepared: March 2009

Abu-Kishk I; Rosenfeld-Yehoshua N. Massive pulmonary hemorrhage in an adolescent. Israel Medical Association Journal 10(8-9): 593-594, 2008. (5 refs.)

Ahonen TM; Kautiainen HJ; Keinanen-Kiukaanniemi SM; Kumpusalo EA; Vanhala MJ. Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein. American Journal of Preventive Medicine 35(6): 598-601, 2008. (26 refs.)

Background: Subclinical inflammation is a novel risk factor of cardiovascular diseases and type 2 diabetes. An inverse association between plasma adiponectin and insulin resistance has been previously shown. Elevated levels of high-sensitivity C-reactive protein (hs-CRP) predict future cardiovascular events. Smoking has been proven to connect with inflammatory markers. There is also evidence of a difference between genders in pro-inflammation. This study aimed to examine the connections among adiponectin, hs-CRP, and smoking and to determine possible gender differences in these associations. Methods: Included were 365 men and 476 women; all were nondiabetic and middle-aged. Daily smoking subjects were considered to be smokers. Adiponectin and hs-CRP were analyzed. Data were collected in 1997-1998, and cytokines were analyzed in 2003. Results: Thirty-five percent of the men and 22% of the women were smokers. In women, the adiponectin level was significantly lower in smokers (6.94 +/- 3.27 mu g/ml) compared to nonsmokers (8.27 +/- 4.72 mu g/ml, p=0.0017). This association remained significant after adjustment for age and BMI (p=0.0061). The hs-CRP level was significantly higher in smoking men (1.59 +/- 1.71 pg/ml) compared to nonsmoking men (1.17 +/- 1.41 pg/ml, p=0.018). This result remained after adjustment for age and BMI (p=0.0056). When smokers were compared to nonsmokers, there was no difference in adiponectin among men or in hs-CRP among women. Conclusions: In the nondiabetic population, smoking associates differently with subclinical inflammation between genders, with a decreased adiponectin level in women and with an increased hs-CRP level in men.

Al-Delaimy WK; Stampfer MJ; Manson JE; Willett WC. Toenail nicotine levels as predictors of coronary heart disease among women. American Journal of Epidemiology 167(11): 1342-1348, 2008. (32 refs.)

The authors assess the ability of toenail nicotine levels as a biomarker to predict incident coronary heart disease (CHD). A nested case-control study was carried out among 62,641 women aged 36-61 years in the Nurses' Health Study cohort who provided toenail clippings in 1982. Between 1984 and 1998, 905 incident CHD cases were diagnosed and matched with two controls by age and date of toenail collection. Using multivariate logistic regression analyses, the authors found a statistically significant dose-response association between increasing toenail nicotine levels and risk of CHD (p(trend) < 0.0001); women in the highest quintile had a relative risk of 3.44 (95% confidence interval (CI): 2.56, 4.62) compared with women in the lowest quintile. With each increase in the log-transformed unit of continuous toenail nicotine levels, there was a 42% increase in the risk of CHD (relative risk = 1.42, 95% CI: 1.33, 1.52). The association remained significant when the number of cigarettes smoked and passive smoking were included as covariates (relative risk = 1.12, 95% CI: 1.01, 1.24). In conclusion, toenail nicotine levels are predictive of CHD among women independent of other risk factors and remained significant even after adjustment for history of cigarette smoking.

Argacha JF; Adamopoulos D; Gujic M; Fontaine D; Amyai N; Berkenboom G et al. Acute effects of passive smoking on peripheral vascular function. Hypertension 51(6): 1506-1511, 2008. (30 refs.)

Environmental tobacco smoke (ETS) acutely affects peripheral and coronary vascular tone. Whether ETS exerts specific deleterious effects on aortic wave reflection through nicotine exposure, whether they persist after ETS cessation, and whether the smoke environment impairs microvascular function and increases asymmetrical dimethyl-arginine levels are not known. We tested these hypotheses in a randomized, crossover study design in 11 healthy male nonsmokers. The effects of 1 hour of exposure to ETS, as compared with a nontobacco smoke and normal air, on augmentation index corrected for heart rate and skin microvascular hyperemia to local heating were examined. Augmentation index increased both during (P = 0.01) and after (P < 0.01) the ETS session but remained unchanged in the nontobacco smoke session when compared with normal air. Nicotine levels after the exposure were related to the peak rise in augmentation index (r = 0.84; P < 0.01), denoting a predominant role of nicotine in ETS vascular effects. This was confirmed in a second set of experiments (n = 14), where the sublingual administration of nicotine was associated with an acute impairment in wave reflection as compared with placebo (P = 0.001). Both ETS and nontobacco smokes increased plasma asymmetrical dimethyl-arginine levels (P < 0.001), but only ETS reduced the late rise in skin blood flow in response to heating (P = 0.03). In conclusion, passive smoking specifically increases aortic wave reflection through a nicotine-dependent pathway and impairs microvascular function, even after the end of the exposure. However, both tobacco and nontobacco passive smoking inhalation increase plasma asymmetrical dimethyl-arginine levels.

Argacha JF; Garcia C; Xhaet O; Gujic M; Preumont N; Van Simaeys G et al. Nicotine does not compromise resting myocardial blood flow autoregulation in smokers at high cardiovascular risk. Nicotine & Tobacco Research 10(7): 1131-1137, 2008. (43 refs.)

Nicotine has been recognized for years as being pharmacologically responsible for the sympathoexcitatory effects of smoking. The effects of nicotine supplementation on myocardial blood flow as assessed by positron emission tomography are, however, unknown. We tested the hypothesis that nicotine substitution could interfere with myocardial blood flow autoregulation at rest in habitual smokers at risk of coronary artery disease. The short-term effect of a 4-mg nicotine tablet on myocardial blood flow was quantified with N-13 ammonia positron emission tomography in 12 smokers with high cardiovascular risk (10 males and 2 females; mean age=58 +/- 8 years; SCORE risk >5%). Nicotine increased systolic blood pressure from 12 +/- 97 to 134 +/- 7 mmHg (p=.03) and heart rate from 67 +/- 2 to 69 +/- 2 bpm (p=.04). As a result, nicotine raised the rate-pressure product from 8618 +/- 622 to 9285 +/- 627 bpmmmHg (p=.02). Nicotine tended to increase myocardial blood flow in the circumflex artery territory, but this effect failed to reach the level of statistical significance (from 0.56 +/- 0.06 to 0.63 +/- 0.03 ml/min/g; p>.15). This trend disappeared when myocardial blood flow was normalized for the rise in the rate-pressure product. Global myocardial perfusion, normalized for the changes in rate-pressure product, remained unchanged from 0.70 +/- 0.06 at baseline to 0.71 +/- 0.03 (ml/min/g)/(bpmmmHg) after nicotine. Nicotine supplementation in habitual smokers with high cardiovascular risk increased myocardial work without compromising resting myocardial blood flow autoregulation.

Aslibekyan S; Levitan EB; Mittleman MA. Prevalent cocaine use and myocardial infarction. American Journal of Cardiology 102(8): 966-969, 2008. (11 refs.)

Studies have reported a possible link between cocaine use and risk for cardiovascular events. The aim of this study was to examine the association between self-reported cocaine use and physician-diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994. Odds ratios (ORs) were estimated using logistic regression models adjusted for age and additionally for gender, race, and other MI risk factors, which accounted for the complex sampling design. In the group aged 18 to 59 years, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR 1.56, 95% confidence interval [CI] 0.44 to 5.50, p = 0.48; multivariate-adjusted OR 1.06, 95% CI 0.30 to 3.73, p = 0.92). Participants who reported using cocaine > 10 times had a nonsignificant higher prevalence of MI (age-adjusted OR 3.13, 95% CI 0.80 to 12.25, p = 0.10; multivariate-adjusted OR 1.84, 95% CI 0.46 to 7.29, p = 0.40). However, participants aged 18 to 45 years who reported > 10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR 4.60, 95% CI 1.12 to 18.88, p = 0.035). The association was attenuated in multivariate-adjusted models (OR 3.84, 95% CI 0.98 to 15.07, p = 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005-2006. In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly in younger populations.

Athanasos P; Farquharson AL; Compton P; Psaltis P; Hay J. Electrocardiogram characteristics of methadone and buprenorphine maintained subjects. Journal of Addictive Diseases 27(3): 31-35, 2008. (15 refs.)

There has been recent concern about the association between high dose methadone and prolongation of QTc in the electrocardiogram. QTc is the time from the beginning of the QRS complex to the end of the T have as measured on an electrocardiogram and corrected for heart rate. To date, no association has been made between methadone and buprenorphine in commonly used doses and prolonged QTc. Electrocardiograms were performed on groups of methadone (n = 35, mean daily dose standard deviation, 69 +/- 29 mg) and buprenorphine (n = 19, mean daily dose 11 5 mg) subjects and a group of non-opioid dependent controls (n = 17). Mean QTc did not differ (p = 0.45) between methadone, buprenorphine, or controls. Methadone subjects were significantly (odds ratio of 7.8) more likely to have U waves than buprenorphine and controls combined. Methadone subjects with U waves were maintained on higher (p = 0.004) doses (89 +/- 29 mg/day) than methadone subjects without U waves (60 +/- 24 mg/day). Methadone subjects taking 60 mg and above had higher (p = 0.02) QTc (405 +/- 29 milliseconds) than methadone subjects taking less than 60 mg per day (381 +/- 27 milliseconds). Although an association is thought to exist between high methadone doses and elongated QTc, methadone and buprenorphine, at commonly used daily doses, remain safe agents for opioid substitution therapy.

Baker A; Richmond R; Castle D; Kulkarni J; Kay-Lambkin F; Sakrouge R et al. Coronary heart disease risk reduction intervention among overweight smokers with a psychotic disorder: Pilot trial. Australian and New Zealand Journal of Psychiatry 43(2): 129-135, 2009. (26 refs.)

Objective: The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing (i) coronary heart disease (CHD) risk; (ii) smoking; and (iii) weight among smokers with psychosis. Secondary dependent variables included physical activity, unhealthy eating, substance use, psychiatric symptomatology, treatment retention, general functioning, and quality of life. Method: This was a feasibility study utilizing a pre-post-treatment design with no control group (n=43). All participants provided written informed consent and were assessed before treatment and again a mean of 19.6 weeks later. The treatment consisted of nine individual 1 h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy, in addition to treatment as usual. Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessments. Results: The intervention was associated with significant reductions in CHD risk scores, smoking and weight. A significant improvement was also reported in level of moderate physical activity, and a small change in the unhealthy eating index was reported. No improvement in biological measures (cholesterol and blood pressure) was evident. Conclusions: A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term. A randomized controlled trial replicating and extending these findings is warranted.

Bernardi L; Casucci G; Haider T; Brandstatter E; Pocecco E; Ehrenbourg I et al. Autonomic and cerebrovascular abnormalities in mild COPD are worsened by chronic smoking. European Respiratory Journal 32(6): 1458-1465, 2008. (39 refs.)

Patients with chronic obstructive pulmonary disease (COPD) may develop hypercapnia and hypoxia, two main determinants of cerebral blood flow. The current authors tested whether cerebrovascular regulation was altered in mild COPD, modified by manoeuvres acutely improving autonomic cardiovascular modulation or influenced by smoking habit. In 15 eucapnic normoxic mild COPD patients (eight smokers) and 28 age-matched controls (14 smokers), midcerebral artery blood flow velocity (MCFV), end-tidal carbon dioxide tension (PET,CO2), arterial oxygen saturation (Sa,O-2), ECG and blood pressure at rest were monitored during progressive hypercapnic hyperoxia, isocapnic hypoxia, slow breathing and oxygen administration. MCFV, arterial baroreflex and dynamic MCFV-blood pressure relationships were compared by phase analysis. COPD and control smokers showed higher MCFV (when corrected for PET,CO2), lower cerebrovascular resistance index and lower sensitivity to hypercapnia than nonsmokers, with equal sensitivity to Sa,O-2 and similar phase analysis. Arterial baroreflex was depressed in all COPD patients. Slow breathing and oxygen administration improved baroreflex sensitivity and reduced MCFV in all COPD patients. Patients with mild chronic obstructive pulmonary disease show autonomic dysfunction. Chronic smoking induces cerebral vasodilation and impairs cerebrovascular control. All abnormalities can be partly corrected by improving the cardio- and cerebrovascular autonomic modulation, suggesting that functional autonomic abnormalities are already present at an early stage of disease.

Bigi MAB; Aslani A; Mehrpour M. Effect of chronic cocaine abuse on the elastic properties of aorta. Echocardiography 25(3): 308-311, 2008. (21 refs.)

Background: Any unfavorable effect of cocaine on aortic elastic properties will contribute to the adverse effects of cocaine on the cardiovascular system. Objectives: The aim of this study was to evaluate the aortic elastic properties in long-term crack cocaine abusers. Methods: Twenty-eight consecutive chronic cocaine abusers and 36 control subjects with similar age, gender, cholesterol, and triglyceride plasma levels, as well as incidence of cigarette smoking, hypertension, and diabetes mellitus were enrolled in the study. Results: The average duration of cocaine abuse was 10 +/- 3.2 years. Diastolic thoracic aortic diameter was increased in cocaine users compared with control subjects (P < 0.05). Aortic strain and distensibility were approximately twofold lower and aortic stiffness index approximately threefold higher in patients compared with control subjects (P < 0.01). The duration of cocaine abuse was related to low aortic strain and distensibility as well as increased aortic stiffness index (R = -0.32, R = -0.38, and R = 0.28, respectively, weighted for age; P < 0.01). When the cocaine abusers were divided into quartiles of duration of cocaine using (first quartile: < 5 years; second quartile: > 5 and < 8 years; third quartile: > 8 and < 11 years; and fourth quartile: > 11 years), progressive increase was found in aortic stiffness index. Conclusion: The present study demonstrates that chronic cocaine abuse clearly produces significant decrease in the elastic properties of aorta. This effect of cocaine is related to the duration of cocaine abuse.

Blank MD; Sams C; Weaver MF; Eissenberg T. Nicotine delivery, cardiovascular profile, and subjective effects of an oral tobacco product for smokers. Nicotine & Tobacco Research 10(3): 417-421, 2008. (17 refs.)

The tobacco industry markets potential reduced exposure products (PREPs) to smokers, including oral products that are intended to be used in situations where cigarettes cannot. For example, Ariva, marketed by Star Scientific, is a tablet made from compressed tobacco powder and is intended for "adult smokers in situations where they cannot or choose not to smoke." No objective data are available regarding Ariva's effects in smokers, including its nicotine delivery, cardiovascular profile, or subjective effects. In this single-session, clinical laboratory study, 10 overnight-abstinent cigarette smokers were administered one Ariva tablet, followed 90min later by two Ariva tablets, followed 90min later by three Ariva tablets. Participants allowed each dose to dissolve in their mouths according to package instructions. Blood was sampled, heart rate monitored, and subjective effects assessed regularly. Ariva delivered nicotine in a dose-dependent manner; mean (SD) nicotine levels increased from 2.4ng/ml (0.9) at baseline, to 3.4ng/ml (1.4) 45min post-1 tablet, 7.3ng/ml (4.0) 45min post-2 tablets, and 9.7ng/ml (4.4) 45min post-3 tablets. Heart rate increased after tablet administration, independent of dose. The tablets also significantly decreased subjective ratings of craving and urge, and increased ratings of nausea. Based on this short-term laboratory evaluation, Ariva exposes users to nicotine and may suppress some symptoms of tobacco abstinence, though its nausea-inducing characteristics may limit initial acceptability.

Bock BC; Becker BM; Niaura RS; Partridge R; Fava JL; Trask P. Smoking cessation among patients in an emergency chest pain observation unit: outcomes of the Chest Pain Smoking Study (CPSS). Nicotine & Tobacco Research 10(10): 1523-1531, 2008. (42 refs.)

This study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking. Participants were adult smokers (N=543) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infarction. Participants were randomly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up. All individuals choosing to quit were offered nicotine patch therapy. Follow-up assessments were conducted at 1, 3 and 6 months. Abstinence (7-day point prevalence) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care (OR=1.62, 95% CI [1.05-2.50]). The largest difference occurred at 1 month: 16.8% of usual care and 27.3% of the tailored intervention group were abstinent, with differences decreasing over time. One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up. In addition to treatment assignment, psychosocial variables including motivation to quit, confidence, reduced temptation to smoke in response to negative affect, and the perception that their chest pain was related to their smoking, were significant predictors of cessation. Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit. Additional intervention may be needed to assist late quitters and to prevent relapse.

Cackett P; Wong TY; Aung T; Saw SM; Tay WT; Rochtchina E et al. Smoking, cardiovascular risk factors, and age-related macular degeneration in Asians: The Singapore Malay Eye Study. American Journal of Ophthalmology 146(6): 960-967, 2008. (58 refs.)

PURPOSE: To assess associations between smoking and cardiovascular risk factors and prevalent age-related macular degeneration (AMD) in the Singapore Malay population. DESIGN: Population-based, cross-sectional study. METHODS: A total of 3,280 Malay adults age 40 to 80 years were included in the study. Early and late AMD signs were graded from retinal photographs following Wisconsin system. All participants had interview, systemic examination, and laboratory investigations to determine smoking status and cardiovascular risk factors. RESULTS: A total of 3,265 participants had gradable photos, 21 (0.6%) with late AMD and 169 (5.2%) with early AMD. After adjusting for age and gender, current smokers were significantly more likely to have late AMD (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.40 to 10.23). This association was stronger among those who currently smoked >5 packs of cigarettes per week (OR, 9.35; 95% CI, 2.49 to 35.08). CONCLUSIONS: Smoking was associated with a higher late AMD prevalence in Malays, consistent with findings from studies in White populations.

Campbell SC; Moffatt RJ; Stamford BA. Smoking and smoking cessation-The relationship between cardiovascular disease and lipoprotein metabolism: A review. (review). Atherosclerosis 201(2): 225-235, 2008. (110 refs.)

Cigarette smoking is generally accepted as the most preventable cause of death in the United States today. Individuals who smoke experience a wide range of physiologic side effects that Increase the risk of cardiovascular disease (CVD), including insulin resistance, elevated catecholamine levels which contribute to an elevated heart rate and blood pressure, and hypercholesterolemia. The link between hypercholesterolemia and cardiovascular disease has been extensively researched and is Undeniable. What is more. this link is strengthened in smokers as cigarette smoking is known to increase total cholesterol (TC), triglycerides (TG) and low-density lipoprotein (LDL). while acting to decrease the cardio-protective high-density lipoprotein (HDL). Alterations in the enzymes that control lipid transport may he a key underlying, mechanism contributing to these health destroying effects. This review examines the current literature related to: (1) smoking, lipoproteins, and lipid-related enzymes: (2) the impact of nicotine, carbon monoxide and free radicals on physiologic parameters related to health: and (3) metabolic issues involving, smoking cessation and nicotine replacement therapy.

Cappelli F; Lazzeri C; Gensini GF; Valente S. Cannabis: a trigger for acute myocardial infarction? A case report. Journal of Cardiovascular Medicine 9(7): 725-728, 2008. (35 refs.)

Cannabis smoking is consistently increasing in Europe and after alcohol it is the most common recreational drug in the western world. Users and lay people believe that marijuana or hashish is safe. Over the past four decades, however, it has been well established that cannabis has pathophysiological effects on the cardiovascular system. Information concerning the link between cannabis consumption and myocardial infarction is limited and existing data are controversial on this topic. In our case report, we describe a case of a young man who after smoking marijuana experienced ST elevation myocardial infarction caused by acute thrombosis of the descending artery, submitted to efficacious primary coronary angioplasty.

Chatters LM; Bullard KM; Taylor RJ; Woodward AT; Neighbors HW; Jackson JS. Religious participation and DSM-IV disorders among older African Americans: Findings from the National Survey of American Life. American Journal of Geriatric Psychiatry 16(12): 957-965, 2008. (35 refs.)

Objectives: This study examined the religious correlates of psychiatric disorders. Design: The analysis is based on the National Survey of American Life (NSAL). The African American sample of the NSAL is a national representative sample of households with at least one African American adult 18 years or over. This study uses the older African American subsample (N = 837). Methods: Religious correlates of selected measures of lifetime Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric disorders (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, obsessive compulsive disorder, posttraumatic stress, major depressive disorder, dysthymia, bipolar I & II disorders, alcohol abuse/dependence, and drug abuse/dependence) were examined. Participants: Data from 837 African Americans aged 55 years or older are used in this analysis. Measurement: The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess mental disorders. Measures of functional status (i.e., mobility and self-care) were assessed using the World Health Organization Disability Assessment Schedule-Second Version. Measures of organizational, nonorganizational and subjective religious involvement, number of doctor diagnosed physical health conditions, and demographic factors were assessed. Results: Multivariate analysis found that religious service attendance was significantly and inversely associated with the odds of having a lifetime mood disorder. Conclusions: This is the first study to investigate the relationship between religious participation and serious mental disorders among a national sample of older African Americans. The inverse relationship between religious service attendance and mood disorders is discussed. Implications for mental health treatment underscore the importance of assessing religious orientations to render more culturally sensitive care.

Comstock GW; Brownlow WJ; Stone RW; Sartwell PE. Cigarette smoking and changes in respiratory findings (Reprinted from Archives of Environmental Health, vol 21, pg 50-57, 1970). American Journal of Epidemiology 168(7): 802-809, 2008. (16 refs.)

Standardized surveys of cardiorespiratory findings were conducted among male telephone company employees 40 to 59 years of age, and repeated five to six yearls later. Cigarettle smokers had considerably more cough, phlegm, and chronic wheeze and slightly more nasal catarrh and breathlessness on exertion than nonsmokers. Pipe and cigar smokers had intermediate levels of these symptoms. Men who quit cigarette smoking between two surveys showed considerable improvement in cough and phlegm. Respiratory symptoms were most common among heavy smokers and among smokers of nonfilter cigarettes. Forced expiratory volume decreased and sputum volume increased among all groups over the observation period. Both changes were least marked among men who quit smoking cigarettes and were most marked among those who continued to smoke cigarettes, especially the heavy smokers and those who used nonfilter cigarettes.

Cruciani RA. Methadone: To ECG or Not to ECG ... That Is still the question. (review). Journal of Pain and Symptom Management 36(5): 545-552, 2008. (55 refs.)

There is significant controversy about the potential deleterious effect of methadone on cardiac conduction. Although several reports suggest that patients receiving methadone are at increased risk for QTc prolongation and torsade de pointes, a potentially fatal arrhythmia, others have not replicated these findings. Hence, it is not surprising that there is no consensus on when to perform an electrocardiogram, a simple test to assess the QTc interval, during methadone therapy. Most of the uncertainty is generated by the lack of large controlled studies. This review presents the current data on this issue in an effort to help in the decision-making process until more conclusive data become available.

Dattilo PB; Nordin C; Hailpern SM. Beta-blockers following cocaine use: A reappraisal - Reply. (letter). Annals of Emergency Medicine 52(1): 89-90, 2008. (0 refs.)

de Ridder S; Eerens F; Hofstra L. Khat rings twice: Khat-induced thrombosis in two vascular territories. Netherlands Heart Journal 15(7-8): 269-270, 2007. (0 refs.)

The stimulant herbal drug Khat has long been known in East Africa and the Arabian peninsula. The habit of showing it has spread to ethnic communities world-wide. This is a case report of a 28 year old African male admitted to an emergency department with chest pain, somnolence and apparent aphasia, which developed after chewing Khat. ECG showed clear signs of inferoposterolateral myocardial infarction. In addition an MRI angiogram showed cerebral infarction due to an occluded left middle cerebral artery. Previous reports suggested that increased myocardial oxygen demand in combination with coronary vasoconstriction could be a major contributing factor to the cardiovascular complications associated with Khat use. This case suggests that increased thrombogenecity could be a key factor.

Doyle F; Mcgee HM; Conroy RM; Shelley E; De la Harpe D. Increase in observed mental health difficulties one year after acute coronary syndrome: general practitioner survey. Irish Journal of Medical Science 176(3): 205-209, 2007. (19 refs.)

Background General practitioners (GPs) are often the first to assess mental health difficulties after acute coronary syndrome (ACS). Aims To determine whether GPs observed an increase in mental health difficulties one- year post- hospitalisation for ACS. Methods Postal survey. Results GPs rated patients (n = 442) as having probable (GP assessed 10%) or definite (formally assessed 7%) mental health difficulties pre-hospitalisation. Post-hospitalisation the prevalence of probable cases increased significantly to 19% (OR = 4.3, 95% CI 2.1-10.2, P < 0.001). In multivariate analysis, only smoking at index hospitalisation was associated with being assessed as a new case of probable/ formal mental health difficulties (RR = 2.1, 95% CI 1.3 - 3.4, P = 0.003). Forty-seven percent of cases were prescribed some medication for this problem. Conclusions GPs recorded a significant increase in mental health difficulties in ACS patients 12 months after hospitalisation, with smoking used as an indicator of new cases.

Dwivedi S; Kumar V; Aggarwal A. Cannabis smoking and acute coronary syndrome: Two illustrative cases. (letter). International Journal of Cardiology 128(2): E54-E57, 2008. (6 refs.)

Cannabis is a common substance of drug abuse among the young adults because of its euphoric and addictive effects. The pathophysiological effects of cannabis smoking and its relation to adverse cardiovascular events are well known. However, the relative contribution of cannabis smoking when combined with tobacco smoking to coronary artery disease is unclear and has not been well emphasized. We describe two cases of acute coronary syndrome occurring in cannabis smokers who were tobacco smoker too. One, a 23 year old young boy who suffered from hypertension and acute coronary syndrome at a very young age and other, a 50 year old male admitted with acute coronary syndrome, developed asymptomatic dynamic electrocardiographic changes and had beta-blocker induced severe bronchospasm. The modifiable nature of cannabis smoking and cigarette smoking, which often go hand in hand, needs no over emphasis. The cessation of twin smoking habits along with correction of other coronary artery disease risk factors is an important part of primary and secondary prevention.

Engelfriet PM; Drenthen W; Pieper PG; Tijssen JGP; Yap SC; Boersma E et al. Smoking and its effects on mortality in adults with congenital heart disease. International Journal of Cardiology 127(1): 93-97, 2008. (15 refs.)

Aims: To describe smoking habits in adults with congenital heart disease (ACHD) and to assess the relationship between smoking exposure and cardiovascular mortality. Methods: Data on smoking history and cardiovascular mortality were extracted from the Euro Heart Survey on adult congenital heart disease a retrospective cohort study, that included patients diagnosed with 1 of 8 subgroups of ACHD (Atrial Septal Defects, Ventricular Septal Defects, Marfan Syndrome, Aortic Coarctation, Tetralogy of Fallot (ToF), Transposition of the Great Arteries (TGA), Fontan circulation, and Cyanotic disease). Results: Complete data of 3375 ACHD patients (median age 28 years) were available for analysis. At inclusion, 9.3% (n=314) were current smokers and 4.2% (n=142) of the patients had smoked in the past. During a median follow-up of 5.1 years, 101 patients (3%) died. In the majority of cases the cause of death was cardiovascular (n=81; 80%). Kaplan-Meier and Cox survival analysis for each of the defects separately showed a significantly increased age and sex-adjusted cardiovascular mortality associated with smoking exposure in TGA patients (Hazard ratio 4.2 (95% CI 1.0-16.8); P=0.044). Also in ToF mortality was higher amongst smokers, though not significantly (HR 3.4 (95% CI 0.6-18.5); P=0.15). In the remaining defects no relationship between smoking and cardiovascular mortality was observed. Conclusion: The prevalence of smoking amongst ACHD patients is relatively low. Smoking exposure is associated with increased cardiovascular mortality in patients with TGA. Prospective long-term follow-up studies are necessary.

Fleury G; De la Garza R; Mahoney JJ; Evans SE; Newton TF. Predictors of cardiovascular response to methamphetamine administration in methamphetamine-dependent individuals. American Journal on Addictions 17(2): 103-110, 2008. (39 refs.)

The goal of the present investigation was to determine predictors of cardiovascular response to methamphetamine administrated in the laboratory. Heart rate (HR) and blood pressure (BP) were measured at baseline and at several time points following the administration of methamphetamine or saline placebo. One-way ANOVA was used to determine the differences between female and male subjects in their cardiovascular response. In male subjects, linear regression and one-way ANOVA were used to determine the influence of potential predictors on cardiovascular response, including age, weight, drug use indicators, concurrent use of other substances, route of administration, and race. Methamphetamine administration provoked significant increases in HR and BP, as compared to placebo. Female gender was associated with larger peak change in diastolic BP following administration. Baseline HR and BP were found to be strong predictors of cardiovascular response to methamphetamine administration in male subjects. Lifetime use and recent use of methamphetamine and nicotine did not predict cardiovascular response to methamphetamine. Recent alcohol use was associated with increased peak change in diastolic BE Also, current use of cannabis was negatively correlated with peak HR change. Male cannabis users show lower peak change in HR as compared to non-cannabis users. As compared to methamphetamine smokers, intravenous users demonstrated higher peak change in diastolic BP following drug administration. Race did not have a significant effect on cardiovascular response. Taken together, these findings may help in the prevention and treatment of cardiovascular events in a population at high risk of premature morbidity and mortality.

Fonseca F; Marti-Almor J; Pastor A; Cladellas M; Farre M; de la Torre R et al. Prevalence of long QTc interval in methadone maintenance patients. Drug and Alcohol Dependence 99(1-3): 327-332, 2009. (33 refs.)

Background: There is a concern about cardiac rhythm disorders related to QTc interval prolongation induced by methadone. A cross-sectional study was designed to evaluate the prevalence of long QTc (LQTc) interval in patients in methadone maintenance treatment (MMT) and risk factors for LQTc. Methods: The study population included 109 Subjects (74 males, median age 43 years). Socio-demographic and toxicological variables were recorded, as well as concomitant use of drugs related with QT prolongation, history of heart diseases, and corrected QT interval by heart rate (QTc) in the ECG. Plasma concentrations of(R)-methadone and (S)-methadone enantiomers were determined in 69 Subjects. Results: Ten patients (9.2%) presented a QTc above 440 ms but a QTc above 500 ins was observed in only 2 Patients with QTc above 440 ms compared with the remaining subjects were older (median [25th-75th percentile range]: 49 [39-56] years vs. 37 [33-43]; Wilcoxon's W = 217.5, p = 0.002) and took a higher daily dose of methadone (median [25th-75th percentile range]: 120 [66-228] mg/day vs. 60 [40-110] mg/day: W = 298.5, p = 0.037). Methadone dose correlated with QTc interval (Pearson's r(2) = 0.291, p = 0.002). Patients with and without long QTc showed no differences in plasma concentrations of (R)-methadone and (S)-methadone enantiomers. Conclusions: The prevalence of LQTc was 9.2%. An association between LQTc and methadone doses was observed but the relationship with plasma concentrations of methadone enantiomers; is unclear.

Frothingham SM; Smith PO; Payne TJ; Meadows SE. How much does smoking cessation cut CHD risk? (editorial). Journal of Family Practice 57(10): 675-676, 2008. (8 refs.)

Fung SCA; Chan YC; Lau FL. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. (letter). Annals of Emergency Medicine 52(1): 88-89, 2008. (1 refs.)

Gaziano JM. Marijuana use among those at risk for cardiovascular events. (editorial). American Heart Journal 155(3): 395-396, 2008. (8 refs.)

This editorial addresses the potential risks of marijuana use particularly among those at higher risk for CVD events. Additional large-scale prospective studies of the short-term and long-term effects of marijuana in older populations and in those with known CVD and risk factors are warranted. In the meantime, it seems advisable to continue to discourage marijuana use in our patients, especially those with known CVD or risk factors. Finally, these findings should cause state regulators to exercise caution before considering use of marijuana for therapeutic purposes.

Hallas J; Bjerrum L; Stovring H; Andersen M. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: A registry-based case-crossover study. American Journal of Epidemiology 168(8): 966-973, 2008. (27 refs.)

Ephedrine and herbal ephedra preparations have been shown to induce a small-to-moderate weight loss. Owing to reports on serious cardiovascular events, they were banned from the US market in 2004. There have been no large controlled studies on the possible association between prescribed ephedrine/caffeine and cardiovascular events in general. The authors linked data from four different sources within Statistics Denmark, using data on 257,364 users of prescribed ephedrine/caffeine for the period 1995-2002. The data were analyzed using a case-crossover technique with a composite endpoint: death outside of a hospital, myocardial infarction, or stroke. To account for effects of chronic exposure and effects in naive users, the authors performed a secondary case-control study nested within the cohort of ephedrine/caffeine ever users. Among 2,316 case subjects, 282 (12.2%) were current users of ephedrine/caffeine. The case-crossover analysis yielded an odds ratio of 0.84 (95% confidence interval: 0.71, 1.00); after adjustment for trends in ephedrine/caffeine use, it was 0.95 (95% confidence interval: 0.79, 1.16). Subgroup analyses revealed no strata with significantly elevated risk. In the case-control substudy, there was no increased risk among naive users or users with large cumulative doses. Prescribed ephedrine/caffeine was not associated with a substantially increased risk of adverse cardiovascular outcomes in this study.

Hart CL; Gunderson EW; Perez A; Kirkpatrick MG; Thurmond A; Comer SD et al. Acute physiological and behavioral effects of intranasal methamphetamine in humans. Neuropsychopharmacology 33(8): 1847-1855, 2008. (39 refs.)

Intranasal methamphetamine abuse has increased dramatically in the past decade, yet only one published study has investigated its acute effects under controlled laboratory conditions. Thus, the current study examined the effects of single-dose intranasal methamphetamine administration on a broad range of behavioral and physiological measures. Eleven nontreatment-seeking methamphetamine abusers (two females, nine males) completed this four-session, in-patient, within-participant, double-blind study. During each session, one of four intranasal methamphetamine doses (0, 12, 25, and 50 mg/70 kg) was administered and methamphetamine plasma concentrations, cardiovascular, subjective, and psychomotor/cognitive performance effects were assessed before drug administration and repeatedly thereafter. Following drug administration, methamphetamine plasma concentrations systematically increased for 4 h postdrug administration then declined. Methamphetamine dose dependently increased cardiovascular measures and 'positive' subjective effects, with peaks occurring approximately 5-15 min after drug administration, when plasma levels were still ascending. In addition, cognitive performance on less complicated tasks was improved by all active methamphetamine doses, whereas performance on more complicated tasks was improved only by the intermediate doses (12 and 25 mg). These results show that intranasal methamphetamine produced predictable effects on multiple behavioral and physiological measures before peak plasma levels were observed. Of interest is the dissociation between methamphetamine plasma concentrations with cardiovascular measures and positive subjective effects, which might have important implications for potential toxicity after repeated doses.

Hastie CE; Haw S; Pell JP. Impact of smoking cessation and lifetime exposure on C-reactive protein. Nicotine & Tobacco Research 10(4): 637-642, 2008. (35 refs.)

C-reactive protein (CRP) levels predict coronary heart disease (CHD) risk. Levels are raised among smokers, but the effect of smoking cessation is unclear. Exposure to secondhand smoke (SHS) may be a confounder. Lifetime smoking exposure may have a dose effect on CRP among smokers, but it is unclear if this persists after cessation. We analyzed cross-sectional data on 4,072 adults recruited to a Scotland-wide population health survey who did not have CHD and were not on nicotine replacement therapy. CRP fell with time from cessation but was still raised up to 5 years after adjustment for case-mix (p <.001). SHS exposure was greater among ex-smokers than neversmokers (median cotinine 0.5 ng/ml vs. 0.4 ng/ml, p <.001) but did not explain the difference. Among smokers, there was a dose relationship between pack years and CRP on both univariate, F(4,1279)=31.841, p <.001, and multivariate, F(4,1085)=3.499, p=.008, analysis. Among ex-smokers there was also a dose relationship between pack-years and CRP, F(4,751)=14.108, p <.001, which was independent of time from cessation and case-mix, F(4,466) = 3.744, p =.005. That CRP does not fall to normal levels immediately and that lifetime smoking exposure continues to impact on CRP levels post cessation suggest that CRP is not raised as a direct effect of cigarette smoke but rather via a secondary mechanism, such as tissue damage causing an inflammatory stimulus. Our results reinforce the need to encourage smoking cessation as early as possible.

Hausberg M; Somers VK. Environmental smoke exposure: A complex cardiovascular challenge. (editorial). Hypertension 51(6): 1468-1469, 2008. (10 refs.)

Hozawa A; Okamura T; Murakami Y; Kadowaki T; Nakamura K; Hayakawa T et al. Joint impact of smoking and hypertension on cardiovascular disease and all-cause mortality in Japan: NIPPON DATA80, a 19-year follow-up. Hypertension Research 30(12): 1169-1175, 2007. (23 refs.)

Hypertension and smoking are major risk factors for death due to cardiovascular disease (CVD). These attributions for CVD mortality should be higher in the countries where obesity-related conditions are uncommon. However, the joint effect of these risk factors on CVD and all-cause mortality have not been described. We followed a representative 8,912 Japanese men and women without a history of stroke and heart disease. Participants were categorized into 4 groups as follows: a group of individuals who neither smoked nor had hypertension (HT), a group of current smokers, a group with HT, and a group of current smokers with HT. We further calculated population-attributable fractions (PAF) of CVD and all-cause mortality based on relative hazards assessed by proportional hazard regression models. After 19 years of follow-up, we observed 313 and 291 CVD and 948 and 766 all-cause deaths for men and women, respectively. The PAF of CVD mortality due to smoking or HT were 35.1% for men and 22.1% for women. The PAF of CVD mortality was higher in participants <60 years of age (57.4% for men and 40.7% for women) vs. those who were older (26.3% for men and 18.1% for women). Aggressive attempts to discourage smoking and to curb HT could yield large health benefits in Japan and throughout Asia, particularly for those aged <60 years. Efforts to warn about the adverse consequence of HT and smoking during adolescence and youth could yield the greatest health benefits, since positive behaviors adopted early are more easily continued into middle adulthood and later life.

Joseph AM; Hecht SS; Murphy SE; Lando H; Carmella SG; Gross M et al. Smoking reduction fails to improve clinical and biological markers of cardiac disease: A randomized controlled trial. Nicotine & Tobacco Research 10(3): 471-481, 2008. (24 refs.)

Cigarette reduction has been proposed as a treatment goal for smokers who are not interested in stopping completely. This randomized controlled trial was designed to determine the effect of a smoking reduction intervention on smoking behavior, symptoms of heart disease, and biomarkers of tobacco exposure. It included 152 patients with heart disease who did not intend to stop smoking in the next 30 days. Participants were randomly assigned to smoking reduction (SR) or usual care (UC). SR subjects received counseling and nicotine replacement therapy to encourage >= 50% reduction in cigarettes per day (CPD). They were followed at 1, 3, 6, 12 and 18 months to assess smoking, heart disease symptoms, quality of life and nicotine, cotinine, carbon monoxide (CO), white blood cell (WBC) count, fibrinogen, hs-C-reactive protein (hs-CRP), F-2-isoprostane, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides (total NNAL), and 1-hydroxypyrene (1-HOP). At 6 months SR participants reduced by 10.9 CPD, compared with 7.4 CPD in UC (difference NS). At 18 months, 9/78 SR vs. 9/74 UC participants quit smoking. There were no significant differences between treatment groups in angina, quality of life or adverse events, nicotine, cotinine, CO, WBC count, fibrinogen, hs-CRP, F-2-isoprostane, total NNAL or 1-HOP levels at any time point. To determine if smoking reduction, regardless of treatment condition, was associated with improved outcomes, we compared all subjects at 6 months to baseline (mean reduction in CPD from 27.4 to 18.1, p<.01). There were no significant changes in outcome variables except CO, which decreased by 5.5ppm (p<.01). There were also no significant improvements considering only subjects who reduced by >= 50%, or those who had no history of reduction prior to enrollment in the study. The SR intervention did not significantly reduce CPD or toxin exposure, or improve smoking cessation or clinical outcomes compared to UC. These results emphasize the importance of abstinence for smokers with heart disease to minimize health risks from tobacco.

Kanneganti P; Huestis MA; Kolbrich EA; Goodwin R; Ziegelstein RC; Gorelick DA. Signal-averaged electrocardiogram in physically healthy, chronic 3,4-Methylenedioxymethamphetamine (MDMA) users. American Journal of Drug and Alcohol Abuse 34(6): 712-720, 2008. (26 refs.)

Objectives: 3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) use has been associated with cardiac arrhythmias. Markers of ventricular late potentials (VLP), which may be a precursor to malignant ventricular arrhythmias, can be detected by signal-averaged electrocardiography (SA-ECG), but not by standard ECG. Methods: We evaluated SA-ECG parameters in 21 physically healthy, recently abstinent MDMA users who also used cannabis (11 males, mean [SD] age 23.3 [4.6] years, 2.8 [2.0] years of use), 18 physically healthy cannabis users (8 males, mean [SD] age 26.6 [7.1] years, 11.2 [5.4] years of use) and 54 non-drug-using controls (21 males, mean [SD] age 28.4 [7.8] years). We analyzed three SA-ECG parameters considered markers of VLPs: duration of filtered QRS complex (fQRS), duration of low amplitude potentials during terminal 40 ms of QRS complex (LAS40), and root mean square voltage during terminal 40 ms of QRS complex (RMS40). Results: MDMA users, cannabis users, and non-drug-using controls did not differ significantly from each other in fQRS, LAS40, or RMS40 values or in the proportion of subjects with abnormal SA-ECG parameters. There were significant gender differences among controls, but not among MDMA users. Conclusion: These findings suggest that chronic MDMA use is neither quantitatively nor qualitatively associated with a high prevalence of abnormal SA-ECG parameters indicative of VLP markers.

Kanneganti P; Nelson RA; Boyd SJ; Ziegelstein RC; Gorelick DA. Exercise stress testing in recently abstinent chronic cocaine abusers. American Journal of Drug and Alcohol Abuse 34(4): 489-498, 2008. (19 refs.)

We compared treadmill exercise stress testing (EST) in 28 medically screened, chronic cocaine users with the cardiovascular effects of an IV cocaine challenge (25 mg or 50 mg). All subjects had a clinically normal EST and echocardiography (except 2 subjects had septal wall hypokinesis). The EST produced significantly greater increases in heart rate and rate-pressure product than did the cocaine challenges. These findings suggest that EST may not provide additional diagnostic information in medically screened cocaine users. EST may cause more cardiac work (indicated by heart rate and blood pressure) than intravenous cocaine (at the doses in this study).

Kaufman DJ; Roman MJ; Devereux RB; Fabsitz RR; MacCluer JW; Dyke B et al. Prevalence of smoking and its relationship with carotid atherosclerosis in Alaskan Eskimos of the Norton Sound region: The GOCADAN Study. Nicotine & Tobacco Research 10(3): 483-491, 2008. (32 refs.)

Since 2000, the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study has been collecting information on cardiovascular disease (CVD) and its risk factors from 1,214 Alaska Natives of the Norton Sound region, a population with increasing rates of heart disease and stroke. Because smoking was reported in a large proportion of the participants, this analysis was undertaken to evaluate smoking patterns and their relation to other risk factors and to CVD. The relationships among smoking habits and demographic factors, body mass index, plasma fibrinogen, prevalent hypertension, and carotid plaque were evaluated. Eighty percent of participants had smoked 100+ cigarettes in their lifetime. Fifty-seven percent of women and 63% of men (p=.12) were current smokers: one in four smokers had quit. Current smokers (OR=2.1; 95% CI=1.1-3.8) and those who had quit <5 years ago (OR=1.6; 95% CI=1.1-2.2) were more likely than non-smokers to have carotid plaque. Pack-years smoked also were correlated with carotid plaque. The high prevalence of smoking and low rates of cessation in this population demonstrate an urgent need for smoking prevention and cessation programs among Alaskan Eskimos of the Norton Sound region and other Alaska Native groups.

Kaufman MJ; Streeter CC; Barros TL; Sarid-Segal O; Afshar M; Tian H et al. Reduced plasma nitric oxide end products in cocaine-dependent men. Journal of Addiction Medicine 1(2): 96-103, 2007. (85 refs.)

Chronic cocaine abusers experience brain and peripheral vascular dysfunction, the severity of which tends to be greater in men than women. The mechanisms underlying these effects of cocaine are unknown. Because nitric oxide (NO) abnormalities play key roles in development of vascular dysfunction in several disorders, we determined whether vascular nitric oxide end product (NOx) levels, which can serve as markers of systemic vascular NO production, are reduced in cocaine-dependent (CD) subjects. Plasma samples from 24 CD men, 12 CD women, and matched comparison subjects (19 men, 14 women) were analyzed with a Sievers 280i nitric oxide chemiluminescence detection analysis system. NOx levels in comparison in women and men were 24.9 +/- 6.6 and 23.3 +/- 5.7 [mu]mol/L, and in CD women and men were 22.5 +/- 8.4 and 13.0 +/- 9.6 [mu]mol/L, respectively. ANCOVA analysis, adjusted for lifetime smoking, indicated group (P < 0.0005) and sex (P = 0.04) effects, both of which survived posthoc Scheffe tests. Reduced NOx levels in CD men drove the group difference. These data suggest that chronic cocaine abuse is associated with reduced NOx levels in men, although the finding also may be attributable to factors indirectly related to cocaine abuse, including cohort differences in other drug use or lifestyle factors. These findings warrant additional studies to more directly characterize vascular NO turnover in cocaine abusers and to establish whether NO abnormalities contribute to cocaine-associated vascular dysfunction and to sex differences in cocaine's effects.

Klatsky AL; Koplik S; Kipp H; Friedman GD. The confounded relation of coffee drinking to coronary artery disease. American Journal of Cardiology 101(6): 825-827, 2008. (19 refs.)

After decades of conflicting studies, the relation of coffee drinking to coronary artery disease (CAD) risk remains unresolved. Using Cox proportional-hazards models with 5 covariates, 127,212 subjects who supplied baseline data at voluntary health examinations from 1978 to 1985 were studied. Subsequently, 8,357 subjects were hospitalized for CAD. Coffee drinking was unrelated to CAD risk in 58,888 never smokers, but in ex-smokers and current baseline smokers, daily coffee intake was associated with higher CAD risk. This disparity was generally consistent in stratified subgroups. In conclusion, this relation of coffee consumption to increased CAD risk only in smokers could be explained by incomplete control for smoking, by other traits of smokers, or by an adverse biologic interaction of a coffee ingredient with smoking effect on CAD.

Koelewijn-van Loon MS; van Steenkiste B; Ronda G; Wensing M; Stoffers HE; Elwyn G et al. Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol). BMC Health Services Research 8(e-article 9), 2008. (75 refs.)

Background: Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management. Methods: A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52 weeks. Clinical endpoints will not be measured, but the absolute 10-year risk of cardiovascular events will be estimated for each patient from medical records at baseline and after 1 year. Discussion: The combined use of risk communication, a decision aid and motivational interviewing to enhance patient involvement in decision making is an innovative aspect of the intervention.

Krantz MJ. Heterogeneous impact of methadone on the QTc interval: What are the practical implications? Journal of Addictive Diseases 27(4): 5-9, 2008. (30 refs.)

Methadone is associated with prolongation of the corrected QT interval (QTc) and torsade de pointes in case series, cross sectional studies, a prospective cohort study, and one randomized trial. It has recently been suggested that methadone promoted sudden cardiac death based on the absence of structural heart disease in an autopsy cohort. Given increasing data linking methadone to arrhythmia, clinicians must understand whether the relationship is causal, and if so, anticipate the expected frequency of QTc interval prolongation in their patients. To date has not been well characterized. To assess the impact of methadone on the QTc interval, electrocardiography at baseline and 6 months after methadone induction was evaluated from a previously published prospective cohort study of heroin addicts. Absolute increases above categorical QTc thresholds and the proportion with QTc interval increases exceeding 30 and 60 msec were tabulated. Among 151 subjects, 76% experienced an increase in QTc, whereas 24% had no change or a decrease. The proportion exceeding 450 msec increased from 7% at baseline to 19% at 6 months; those exceeding 500 msec increased from 0% to 2%. Although 18% of subjects had an increase in QTc of 30 msec, only 3% had an increase exceeding 60 msec. Most methadone-treated patients develop QTc prolongation. However, critical QTc prolongation (exceeding 500 msec or increases exceeding 60 msec) occurred infrequently. This highlights the heterogeneity of QTc interval changes and measurement variability but also implies that electrocardiography screening among opioid dependent patients would only occasionally require methadone discontinuation.

Kung CM; Wang HL; Tseng ZL. Cigarette smoking exacerbates health problems in young men. Clinical and Investigative Medicine 31(3): E138-E149, 2008. (48 refs.)

Purpose: To examines the hypothesis that smoking exacerbates health problems in young male smokers (age range, 18.6-22.8 yr; mean, 19.4 yr). Methods: 1169 subjects were recruited, 25.41 % were smokers (2-15 cigarettes daily). All subjects were examined for body mass index, blood pressure, exhaled carbon monoxide content (carboxyl hemoglobin), blood hematology and biochemistry. Results: Data for WBC (P < 0.001), hemoglobin (P=0.001), hematocrit (P=0.004), MCV (P=0.001), MCH (P=0.003), COHB% (P < 0.001), albumin /globulin (P < 0.001) and triglyceride (P < 0.001) were higher for smokers than nonsmokers, while total-bilirubin (P < 0.001), total protein (P < 0.001) and globulin (P < 0.001) were markedly lower. The results of WBC (r=0.164, P < 0.004), COHB% (r=0.958, P < 0.001), gamma glutamyl transpeptidase (r=0.159, P=0.006), alkaline-phosphatase (r=-0.154, P=0.008) and triglyceride (r= 0.144, P < 0.001) were closely correlated with number of cigarettes smoked daily. Investigation of associations with illness revealed that young smokers had an increased risk of hypertriglyceridemia to young non-smokers (adjusted ORs, 2.124; 95% CIs, 1.414-3.190), hyperglycemia (adjusted ORs, 1.980; 95% CIs, 0.803-4.901), neutrophilia (adjusted ORs, 1.947; 95% CIs, 1.248-3.037), RBC macrocytosis (adjusted ORs, 1.929; 95% CIs, 1.137-3.275), hyperchromia (adjusted ORs, 1.844; 95% CIs, 1.412-2.407) and polycythemia (adjusted ORs, 1.314; 95% CIs, 0.805-2.145) (all P < 0.05 for linear trends). Conclusion: The findings emphasize the importance of increasing surveillance of diseases exacerbated by smoking and reducing smoking in the young to prevent cardiovascular illnesses, metabolite disorders and other clinical diseases.

Leone A; Landini L; Biadi O; Balbarini A. Smoking and cardiovascular system: Cellular features of the damage. Current Pharmaceutical Design 14(18): 1771-1777, 2008. (85 refs.)

Two morphological features may be seen as a main result of the cardiovascular cell damage caused by cigarette smoking: myocardial cell necrosis and smoke cardiomyopathy that, however, can lead to cell necrosis in case of chronic prolonged exposure to tobacco smoke. Both these pathological patterns recognise hypoxia as the basic mechanism. Cardiovascular cell damage may involve either myocardial cell or coronary artery wall determining a varied but a wide spectrum of alterations. Necrosis may be well defined as a result of those morphological changes which follow cell death in a living tissue or organ with partial or total loss in their function. All infarcts of the heart muscle belong to the group of necrotic lesions, but not all cardiac necroses are necessarily infarcts. Coronarogenic, or non-coronarogenic mechanism following a direct action of tobacco compounds on myocardial cells may induce myocardial cell necrosis. Smoke cardiomyopathy is probably the most typical evidence of cellular damage induced by cigarette smoking on the myocardium. The term cardiomyopathy is used to describe all those forms of degenerative myocardial lesions caused directly by toxics or metabolic substances and, indirectly, by changes in blood flow which are able to induce chronic hypoxia. Initially, smoke cardiomyopathy is not characterised by necrotic phenomena but, instead, by alterations of those intracellular structures RNA-related like mitochondria and ribosomes, which are primarily deputed to carry out metabolic and respiratory pathways of myocardial cells, the function of which strongly depends on oxygen availability. Experimental findings documented undoubtedly either the type of cellular changes or their reproducibility after both acute or chronic exposure to cigarette smoke.

Levin KH; Copersino ML; Epstein D; Boyd SJ; Gorelick DA. Longitudinal ECG changes in cocaine users during extended abstinence. Drug and Alcohol Dependence 95(1/2): 160-163, 2008. (9 refs.)

Background: Cocaine lengthens electrocardiographic QTc, QRS and PR intervals through blockade of sodium and potassium channels, but changes during withdrawal have not been well studied. Methods: We recorded weekly electrocardiograms (ECGs) from 25 physically healthy cocaine users (84.0% men, mean [S.D.] age 34.7 [4.1] years, 9.0 [5.2] years of cocaine use, 9.4 [3.5] days of use in the 2 weeks prior to admission) over 3 months of monitored abstinence on a closed ward. Subjects had minimal current use of other drugs. Baseline ECGs were recorded 20.5 h [16.6] after last cocaine use. Results: Baseline QTc interval correlated positively with total amount of cocaine used and amount used per day in the 2 weeks prior to ward admission. There was a significant 10.5 ms [12.9] shortening of QTc interval during the first week of withdrawal, with no further significant changes thereafter. There were no significant changes in PR or QRS intervals. Conclusions: These findings suggest that cocaine-associated QTc prolongation returns toward normal during the first week of cocaine abstinence.

Li WW; Froelicher ES. Predictors of smoking relapse in women with cardiovascular disease in a 30-month study: Extended analysis. Heart & Lung 37(6): 455-465, 2008. (38 refs.)

PURPOSE: To identify predictors of long-term cessation after intervention for woman hospitalized with cardiovascular diseases (CVD). METHODS: A randomized clinical trial (RCT) with a 30-month follow-up was conducted, recruiting 277 woman smokers with CVD from 10 hospitals. The intervention consisted of inpatient and outpatient counseling on smoking cessation and pharmacological protocol. Psychophysiological factors and time since quitting associated with relapse in the literature were assessed in our prediction model. RESULTS: The nine independent variables for smoking relapse included time since quitting, group assignment, the interaction between time and group assignment, serious quit attempts and five and psychophysiological factors. Lower self-efficacy at baseline was a significant predictor of relapse (OR = 0.98, 95%CI = 0.97,0.99). Another predictor was the interaction between time and group assignment and the finding showed that for the usual care group, increase in time since quitting provided a significant protective factor (OR = 0.69, 95%CI = 0.60,0.79). CONCLUSIONS: Cessation programs should include content on self-efficacy to help prevent relapse. The interaction between time and group warrants further investigation for its prediction for relapse.

Lin WY; Chiu TY; Lee LT; Lin CC; Huang CY; Huang KC. Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men. American Journal of Clinical Nutrition 87(5): 1204-1211, 2008. (35 refs.)

Background: Betel nut chewing is related to several kinds of cancer, metabolic syndrome, and type 2 diabetes. Whether it is associated with a greater risk of cardiovascular disease (CVD) and all-cause mortality, however, remains unclear. Objective: We aimed to investigate the association between betel nut chewing and CVD and all-cause mortality. Design: A baseline cohort of 56 116 male participants >= 20 y old were recruited from 4 nationwide health screening centers in Taiwan in 1998 and 1999. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all-cause mortality for betel nut chewers during an 8-y follow-up period. Results: There were 1549 deaths during the follow-up period, 309 of which were due to CVD. After adjustment for age, body mass index, diabetes, hypertension, lipids, smoking, alcohol consumption, physical activity, income, and education level, the RRs (95% CI) of CVD and all-cause mortality among the former betel nut chewers were 1.56 (1.02, 2.38) and 1.40 (1.17, 1.68), respectively, and those among current chewers were 2.02 (1.31, 3.13) and 1.40 (1.16, 1.70), respectively, compared with persons who had never chewed betel quid. Current and former betel nut chewers had a higher risk of CVD mortality (RR: 2.10; P < 0.05) than did current and former smokers. Greater frequency of betel nut chewing was associated with greater CVD and all-cause mortality. Conclusions: Betel nut chewing was independently associated with a greater risk of CVD and all-cause mortality in Taiwanese men. Regular screening for betel nut chewing history may help prevent excess deaths in the future. An anti-betel nut chewing program is urgently warranted for current chewers.

Lynch WJ; Kalayasiri R; Sughondhabirom A; Pittman B; Coric V; Morgan PT et al. Subjective responses and cardiovascular effects of self-administered cocaine in cocaine-abusing men and women. Addiction Biology 13(3/4): 403-410, 2008. (18 refs.)

This study aimed to examine sex differences in cocaine self-administration and cocaine-induced subjective and cardiovascular measures. The research was based on secondary analysis of data collected in our human laboratory in which subjects self-administered cocaine infusions (8, 16 and 32 mg/70 kg) over a 2-hour period under a fixed ratio 1, 5 minute time out schedule in three test sessions. Subjects were 10 women and 21 men with a history of either cocaine abuse or dependence who were not currently seeking treatment. Women and men self-administered similar amounts of cocaine. None of the subjective effects measures showed a significant main effect of sex during the cocaine self-administration session. Significant interactions were observed for subjective ratings of 'high' (sex x time) and 'stimulated' (sex x time x dose), with women reporting lower ratings over time/doses than men. Relative to men, cocaine produced dose- and time-dependent increases in feelings of hunger (i.e., reduced appetite suppression) in women. Systolic and diastolic blood pressures showed different patterns of change in men and women, with women showing less robust cocaine-induced increases than men. Taken together, these findings suggest that women and men may differ in their subjective and cardiovascular responses to self-administered cocaine. Further research that prospectively controls for hormonal influences upon these measures is needed.

MacEwen C; Ward M; Buchan A. A case of cocaine-induced basilar artery thrombosis. (review). Nature. Clinical Practice Neurology 4(11): 622-626, 2008. (17 refs.)

Background: A 40-year-old man presented to an emergency department with slurred speech, diplopia and agitation several hours after cocaine use. His level of consciousness rapidly dropped in the hours following presentation. Investigation Physical examination, CT scan of the head, cerebral angiography. Diagnosis Cocaine-induced basilar artery thrombosis. Management Intra-arterial thombolysis, mechanical clot aspiration, intravenous abciximab, neurointensive care support, rehabilitation at a specialist stroke unit.

Mariani PJ. Beta-blockers following cocaine use: A reappraisal. (letter). Annals of Emergency Medicine 52(1): 89-89, 2008. (4 refs.)

Marks DH. Cardiomyopathy due to ingestion of Adderall. American Journal of Therapeutics 15(3): 287-289, 2008. (9 refs.)

A patient is described who developed cardiomyopathy after receiving a therapeutic course of dextroamphetamine/amphetamine. The patient's cardiac function deteriorated to the point of heart failure, necessitating a heart transplantation. Cardiomyopathy associated with amphetamine use is a serious and potentially lethal condition. With early diagnosis, identification of the cause, and treatment, cardiomyopathy may be reversible. The dangers of therapeutic use of amphetamines are discussed, as well as problems and assumptions associated with U.S. Food and Drug Administration monitoring and removal from the market of harmful substances.

Mccance-Katz EF. Opioids and cardigram abnormalities: Providing treatment based on understanding the risks and benefits. (editorial). Addiction 103(12): 1994-1995, 2008. (19 refs.)

McCord J; Jneid H; Hollander JE; de Lemos JA; Cercek B; Hsue P et al. Management of cocaine-associated chest pain and myocardial infarction - A scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. (review). Circulation 117(14): 1897-1907, 2008. (111 refs.)

Cocaine is the second most commonly used illicit drug in the United States, with marijuana use more frequently. Cocaine is also the illicit drug that leads to the most ED visits. In 2005, there were 448,481 cocaine-related visits to EDs in the United States. Chest discomfort has been reported in 40% of patients who present to the ED after cocaine use. The Drug Abuse Warning Network (DAWN) reported that in the last 6 months of 2004, there were 126,000 cocaine-related ED visits in the United States, or 40% of all ED visits related to substance abuse (illicit or otherwise). The most frequent age group for these visits was 35 to 44 years of age; this group accounted for 37% of all cocaine-related ED encounters. Cocaine-related ED visits increased by 47% from 1999 to 2002. Thus, the number of ED encounters with patients with cocaine-associated chest pain will likely be increasing. This article provides guidelines for management of cocaine-associated chest pain and myocardial infarction . It reviews the epidemiology of cocaine use, pathophysiology, incidence of myocardial infarction, clinical presentation, timing between cocaine use and MI, patient characteristics, complications and prognosis, diagnostic strategie, myocartdiao perfusion imaging, therapeutic strategies, ST-segment-elevation MI, and discharge management and secondary prevention.

Meyers DG; Neuberger JS. Cardiovascular effect of bans on smoking in public places. (editorial). American Journal of Cardiology 102(10): 1421-1424, 2008. (22 refs.)

Mizia-Stec K; Gasior Z; Wojnicz R; Haberka M; Mielczarek M; Wierzbicki A et al. Severe dilated cardiomyopathy as a consequence of Ecstasy intake. Cardiovascular Pathology 17(4): 250-253, 2008. (12 refs.)

Dilated cardiomyopathy (DCM) is one of the most common causes of heart failure with a prevalence of 1:2500. There are several primary and secondary etiologic factors, including gene mutations, infection agents, particularly viruses, toxins, autoimmune, and systemic disorders, and pheochromocytoma, neuromuscular, metabolic, mitochondrial, and nutritional disorders. However, a precise diagnosis can be reached only in no more than 50% of all cases. Herein, we report a rare case of hepatic damage and severe DCM as a consequence of relatively popular socially used narcotic-Ecstasy (3,4-methylenedioxy-N-methylamphetamine [MDMA]).

Montisci M; Thiene G; Ferrara SD; Basso C. Cannabis and cocaine: a lethal cocktail triggering coronary sudden death. (editorial). Cardiovascular Pathology 17(5): 344-346, 2008. (5 refs.)

The case of a 31-year-old man who died suddenly, with a history of drug abuse and no risk factors for coronary artery disease, is herein reported. Postmortem examination disclosed critical stenosis due to a fibrocellular atherosclerotic plaque complicated by occlusive thrombosis at the level of the left anterior descending coronary artery. Chemico-toxicological analysis revealed high levels of cocaine, tetrahydrocannabinol, and metabolites. When dealing with an acute coronary syndrome in young people, with or without a history of drug abuse, toxicological examination should always be performed to rule out unnatural causes of myocardial ischemia.

Mukamal KJ; Maclure M; Muller JE; Mittleman MA. An exploratory prospective study of marijuana use and mortality following acute myocardial infarction. American Heart Journal 155(3): 465-470, 2008. (38 refs.)

Background: The relationship of marijuana use with coronary heart disease, including prognosis among patients with coronary heart disease, is uncertain. Methods: We conducted an inception cohort study of 1913 adults hospitalized with myocardial infarction at 45 US hospitals between 1989 and 1994, with a median follow-up of 3.8 years. We ascertained total mortality according to self-reported marijuana use in the preceding year. Results: A total of 52 patients reported marijuana use during the prior year, and 3 17 patients died during follow-up. Compared with nonuse, marijuana use less than weekly was associated with a hazard ratio of 2.5 (95, % CI, 0.9-7.3). The corresponding hazard ratio for weekly use or more was 4.2 (95% CI, 1.2-14.3). The age- and sex-adjusted hazard ratios associated with any use were 1.9 (95% CI, 0.6-6.3) for cardiovascular mortality and 4.9 (95% CI, 1.6-14.7) for noncardiovascular mortality. In a comparison of 42 marijuana users and 42 other patients matched on propensity scores, there were 6 deaths among marijuana users and one among non-users (log-rank P = .06). Conclusions These preliminary results suggest possible hazards of marijuana for patients who survive acute myocardial infarction. Although marijuana use has not been associated with mortality in other populations, it may pose particular risk for susceptible individuals with coronary heart disease.

Munn Z. Psychosocial interventions for smoking cessation in patients with coronary heart disease. (summary). Journal of Advanced Nursing 64(5): 457-458, 2008. (1 refs.)

This column provides a summary of a systematic review on nursing-related issues from the Cochrane Library. The article summarized is by Barth J, Critchley J. & Bengel J. (2008) Psychosocial interventions for smoking cessation in patients with coronary heart disease. Cochrane Database of Systematic Reviews, Issue 1, Art. No: CD006886.

Mushtaq F; Mondelli V; Pariante CM. The metabolic implications of long term cannabis use in patients with psychosis. Journal for Epidemiology and Psychiatric Sciences 17(3): 221-226, 2008. (44 refs.)

Aims - The aim of this paper is to summarise the effects of cannabis use on appetite and energy balance, and to subsequently investigate the possible implications this may have in patients with psychosis, in whom a high prevalence of cannabis use has been reported. Methods - A narrative review based on the recent literature regarding cannabis use in the general population and patients with psychosis. Results - The short-term abilities of cannabis to increase appetite and body weight, through actions on the endogenous endocannabinoid system, have been well characterised throughout the literature. The long term effects of cannabis use are however unclear and only a minority of studies have been conducted in the genera. population with overall conflicting results. In terms of the effects of cannabis in patients with psychosis, there has only been one study to date that has investigated this and interestingly found cannabis use to be associated with increased body weight and blood glucose levels, thus providing evidence that cannabis use may be an important contributing factor to the reduced life expectancy, as is Currently observed in this vulnerable patient group. Conclusions - It is clear from the literature that patients with psychosis are at a high risk of metabolic and cardiovascular disease in comparison to the general population. However the contribution of cannabis use to this risk is as of yet undetermined and further long term studies are need to confirm current findings and evaluate hypothesised mechanisms.

Nair MK; Patel K; Starer PJ. Ciprofloxacin-induced torsades de pointes in a methadone-dependent patient. Addiction 103(12): 2062-2064, 2008. (21 refs.)

Methadone has been associated with QT prolongation and Torsades de pointes. Ciprofloxacin may prolong QT interval and induce Torsades de pointes when other risk factors are present. A case is described in which a patient receiving methadone treatment developed Torsades de pointes following the addition of ciprofloxacin. Ciprofloxacin should be used with caution in patients receiving methadone.

Nakamura K; Barzi F; Lam TH; Huxley R; Feigin VL; Ueshima H et al. Cigarette smoking, systolic blood pressure, and cardiovascular diseases in the Asia-Pacific region. Stroke 39(6): 1694-1702, 2008. (35 refs.)

Background and Purpose-Smoking and increased levels of blood pressure (BP) substantially increase the risk of cardiovascular diseases (CVD). If these 2 risk factors have a synergistic impact on cardiovascular events, lowering BP and quitting smoking will contribute more to reducing CVD than would be expected from ignoring their interaction. Methods-Individual participant data were combined from 41 cohorts, involving 563 144 participants (82% Asian). During a median of 6.8 years follow-up, 4344 coronary heart disease (CHD) and 5906 stroke events were recorded. Repeat measures of systolic blood pressure (SBP) were used to adjust for regression dilution bias. Hazard ratios (HRs) and 95% confidence intervals (CIs) for SBP by cigarette smoking status were estimated from Cox proportional hazard models adjusted for age and stratified by study and sex. Results-Data suggested a log-linear relationship between SBP and all subtypes of CVD. The HRs relating SBP to both CHD and ischemic stroke were broadly similar irrespective of smoking status (P >= 0.1). For hemorrhagic stroke (intracerebral hemorrhage), the HRs (95% CIs) for an additional 10 mm Hg increment in SBP were 1.81 (1.73 to 1.90) for present smokers and 1.66 (1.59 to 1.73) for nonsmokers (P = 0.003). For every subtype of cardiovascular events, similar results were found for analyses involving only fatal events. Conclusions-Smoking exacerbated the impact of SBP on the risk of hemorrhagic stroke. Although quitting smoking and lowering BP are both crucial for prevention of CVD, combining the 2 could be expected to have extra beneficial effect on preventing hemorrhagic stroke.

Newman RG. Attributing fatal cardiac effects to methadone: What's the evidence? (editorial). Journal of Addictive Diseases 27(4): 1-4, 2008. (22 refs.)

Noda H; Iso H; Toyoshima H; Date C; Yamamoto A; Kikuchi S et al. Smoking status, sports participation and mortality from coronary heart disease. Heart 94(4): 471-475, 2008. (23 refs.)

Background: Since smoking and exercise have opposite effects on coronary risk factors, the hypothesis was proposed that smoking might weaken the protective effect of exercise on prevention of coronary heart disease. Objective: To determine the effect of smoking on the relationship between sports participation and mortality from coronary heart disease. Design: Population-based prospective cohort study in Japan. Participants: A total of 76 832 Japanese men and women, aged 40-79 years with no history of stroke, coronary heart disease, or cancer, completed a self-administered questionnaire between 1988 and 1990. Main outcome measures: Systematic mortality surveillance was carried out through 2003, and 638 deaths from coronary heart disease (496 myocardial infarction) were identified. Results: People who reported the longest time in sports participation (>= 5 hours/week) had an approximately 50-80% lower age-adjusted risk of mortality from coronary heart disease compared with those in the second lowest category (1-2 hours/week) among never and ex-smokers, but no association was found among current smokers. Adjustment for known risk factors and exclusion of subjects who died within 2 years of the baseline inquiry did not substantially alter these associations. The multivariable hazard ratios (95% confidence interval) of coronary heart disease for the >= 5 hours/week versus 1-2 hours/week of sports participation were 0.44 (0.23 to 0.86) among never smokers, 0.18 (0.05 to 0.60) among ex-smokers, and 0.82 (0.47 to 1.40) among current smokers. Similar associations were found for men and women. Conclusions: Smoking may reduce the beneficial effect of sports participation for reduction of fatal coronary heart disease.

O'Loughlin J; Lambert M; Karp I; McGrath J; Gray-Donald K; Barnett TA et al. Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents. Nicotine & Tobacco Research 10(3): 525-532, 2008. (46 refs.)

Although related to inflammatory markers in adults, little is known about the association between cigarette smoking and C-reactive protein (CRP) in adolescent smokers. We examined the association between high-sensitivity CRP (hs-CRP) concentrations and smoking in youth. We used data from a cross-sectional, province-wide survey of a representative sample of youth conducted in Quebec, Canada, in 1999. Data were collected in self-report questionnaires completed by participants and their parents. Participants provided a fasting blood sample, and anthropometric measures were undertaken by trained technicians. The present analysis pertains to 1,501 adolescents aged 13 and 16 years who completed questionnaires and for whom blood samples were available. The independent association between a six-category indicator of smoking status and elevated hs-CRP, defined as a value at least in the 90th percentile of the age- and sex-specific CRP distribution, was assessed in multiple logistic regression analyses controlling for potential confounders. Relative to never-smokers, the odds ratios (95% confidence intervals) for puffers (i.e., never smoked a whole cigarette), those who smoked but not in the past month, light past-month smokers, moderate past-month smokers, and heavy past-month smokers were 1.04 (0.55-1.98), 1.76 (1.06-2.94), 1.39 (0.70-2.76), 2.07 (0.96-4.42), and 2.40 (1.18-4.88), respectively. Our data suggest a positive association between smoking status and elevated CRP in adolescents, and in particular among heavier past-month smokers. Damage related to cigarette smoking may begin soon after tobacco use initiation, reinforcing the preventive message that no level of smoking is safe in youth.

Papathanasiou G; Georgakopoulos D; Georgoudis G; Spyropoulos P; Perrea D; Evangelou A. Effects of chronic smoking on exercise tolerance and on heart rate-systolic blood pressure product in young healthy adults. European Journal of Cardiovascular Prevention & Rehabilitation 14(5): 646-652, 2007. (45 refs.)

Background: Smoking is a major cause of cardiovascular disease and mortality. Smoking-related deaths in Greece account for 23%, whereas 41 % of young Greeks are smokers, the highest percentage in Europe. The purpose of this study was to examine the effects of chronic smoking on the rate-pressure product and exercise tolerance in young, healthy male smokers. Design and methods: Forty-two smokers and 51 nonsmokers were selected from a population of 543 students based on their age, sex, body mass index, physical fitness, smoking habit and health status. All participants were tested with the standard Bruce treadmill protocol. The rate-pressure product was obtained at rest and during exercise at a given submaximal workload. The evaluation of exercise tolerance was based on peak workload achieved and maximal exercise test duration. Results: The smokers had a higher rate-pressure product at rest (P < 0.001) due to their higher resting heart rate (P < 0.001). Resting values of blood pressure did not differ significantly between the two groups. During exercise, smokers had a greater rate-pressure product (P < 0.001), mainly due to their significantly higher systolic blood pressure (P = 0.008). The smokers had a higher submaximal heart rate (P=0.005), but the differences in heart rate between groups were reduced for smokers during exercise when compared to rest The smokers' exercise tolerance was impaired and their maximal exercise test duration time was significantly shorter (P < 0.001). Conclusions: Chronic smoking was found to affect young male smokers' cardiovascular fitness, impairing the economy and decreasing the capacity of their circulatory system.

Rahman MA; Zaman MM. Smoking and smokeless tobacco consumption: Possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in Bangladesh. Public Health 122(12): 1331-1338, 2008. (26 refs.)

Objectives: To determine the risk of coronary heart disease (CHD) associated with various types of tobacco consumption among young patients aged 20-49 years attending a tertiary care cardiac hospital in Bangladesh. Study design: Case-control study. Methods: The study was undertaken at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. The study population comprised 69 cases with CHD and 138 controls without CHD from the emergency department of NICVD. Quantitative interviews were performed. Results: Most of the cases (79.7%) were either current or past consumers of some form of tobacco, compared with less than half of the controls (46.4%). The increased risk of CHD was approximately four fold in ever smokers [adjusted odds ratio (OR)4.0, 95% confidence interval (0) 1.7-9.5] and cases who had ever used smokeless tobacco (adjusted OR 4.0, 95% CI 2.0-8.1). Smokeless tobacco consumption was strongly associated with CHD after adjustment for smoking and other confounders. Conclusion: This study found evidence for an association between various types of tobacco consumption and CHD, particularly for bidi smoking and different types of smokeless tobacco consumption. Policies should be made and implemented to combat bidi smoking and smokeless tobacco consumption, as well as cigarette smoking.

Rajab R; Stearns E; Baithun S. Autopsy pathology of cocaine users from the Eastern district of London: A retrospective cohort study. Journal of Clinical Pathology 61(7): 848-850, 2008. (19 refs.)

Aim: To establish the most frequent pathological findings encountered at postmortem examination during the investigation of a fatality with a history of cocaine abuse. Methods: Autopsied deaths investigated by the coroner for the Eastern district of London, between 2004 and 2007, in which the decedent had positive toxicology for cocaine were identified (n = 28). The autopsy records and histology of tissue taken at autopsy were retrieved and reviewed. Pathological findings (gross and microscopic, including cardiac, pulmonary, gastrointestinal, hepatobiliary, renal and neurological) were collated. Results: The main pathological findings at autopsy occurring in this cohort (comprising predominantly men, mean age 31 years), were cardiovascular: left ventricular hypertrophy (46%), multifocal myocardial fibrosis (21%), coronary artery disease (29%), cerebrovascular disease (36%) and pulmonary oedema (71%). Hepatic steatosis (29%) and gastrointestinal haemorrhage (18%), due mostly to gastric erosions/ulceration, were also frequent findings. Conclusions: During a coroner's autopsy of a cocaine user, a thorough cardiac examination combined with cardiac tissue sampling for histology, are valuable investigations, which are most likely to help show pathology relevant to the cause of death.

Rallidis LS; Lekakis J; Panagiotakos D; Fountoulaki K; Komporozos C; Apostolou T et al. Long-term prognostic factors of young patients (<= 35 years) having acute myocardial infarction: The detrimental role of continuation of smoking. European Journal of Cardiovascular Prevention & Rehabilitation 15(5): 567-571, 2008. (28 refs.)

Background: There are few and conflicting data regarding the prognostic role of continued smoking in very young survivors of acute myocardial infraction (AMI) after the event. Design: We conducted a prospective study to evaluate the impact of smoking habits on long-term outcome in individuals who sustained AMI at the age of <= 35 years. Methods: We recruited 147 consecutive patients who had survived their first AMI at the age of <= 35 years. Patients were followed up for up to 10 years. Clinical end points were: readmission for acute coronary syndrome, cardiac death or coronary revascularization because of clinical deterioration. Results: The most prevalent risk factor at presentation was smoking (94.8%). Follow-up data were obtained by 135 patients (32 +/- 3 yeas old, 115 men). During follow-up 75 (55.6%) patients reported continuation of smoking. Forty-four (32.6%) patients presented cardiac events (three cardiac deaths, 30 acute coronary syndromes, and 11 revascularizations). Multivariable data analysis showed that persistence of smoking (relative risk=2.35, 95% confidence interval 1.5-5.25, P=0.03) and ejection fraction at presentation (relative risk=0.95, 95% confidence interval 0.91-0.98, P=0.008) were the only significant predictors of cardiac events after adjusting for various confounding factors. In addition, continuation of smoking was the most significant predictor of cardiac events during follow-up in our sample (i.e. had the lowest log-likelihood ratio as compared covariates). Conclusion: Persistence of smoking is the most powerful predictor for the recurrence of cardiac events in patients with premature AMI.

Reeves GR; Wang TY; Reid KJ; Alexander KP; Decker C; Ahmad H et al. Dissociation between hospital performance of the smoking cessation counseling quality metric and cessation outcomes after myocardial infarction. Archives of Internal Medicine 168(19): 2111-2117, 2008. (37 refs.)

Background: Recognizing the importance of smoking cessation after acute myocardial infarction (AMI), the Centers for Medicare & Medicaid Services and the joint Commission on Accreditation of Healthcare Organizations currently uses documentation of smoking cessation counseling (SCC) as a metric of hospitals' quality of AMI care. Yet, the association between hospitals' performance of this quality measure and subsequent tobacco cessation rates has not been established. Methods: We analyzed 889 consecutive smokers treated for AMI at 19 hospitals in PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) between January 1, 2003, and June 28, 2004. Patients were followed up for I year after hospitalization. Multivariate regression modeling was performed to determine the association between hospital-level documented SCC rates and tobacco cessation rates after discharge. Results: On a hospital level, the median medical record-documented SCC rate was 72.0% (interquartile range, 59.6%-90.1%). At 1 year, the median smoking cessation rate was 55.6% (interquartile range, 37.5%-61.9%). Although patients with documented SCC were more likely to recall receiving SCC at I month (86.1% vs 70.8%, P < .001), their rate of quitting at 1. year was lower than that of patients without. documented SCC (50.1%vs60.7%, P=.02-, relative risk, 0.76; 95% confidence interval, 0.61-0.94). At the hospital level, there was no correlation between SCC documentation and successful quitting at 6 months (r=-0.19, P=.11) or 1 year (r=-0.13, P=.45). Conclusions: The performance metric for SCC, as it is currently structured, does not correlate with actual smoking cessation at 6 months or 1. year. Revision of this performance measure should be considered to more effectively reflect the goal of promoting smoking cessation.

Rodondi N; Auer R; Devine PJ; O'Malley PG; Hayoz D; Cornuz J. The impact of carotid plaque screening on motivation for smoking cessation. Nicotine & Tobacco Research 10(3): 541-546, 2008. (24 refs.)

Showing smokers their own atherosclerotic plaques might increase motivation for smoking cessation, since they underestimate their own risk for smoking-related diseases. To assess the feasibility and optimal processes of studying the impact of carotid atherosclerotic plaque screening in smokers, we enrolled 30 daily cigarette smokers, aged 40-70 years, in an observational pre-post pilot study. All smokers underwent smoking cessation counseling, nicotine replacement therapy, a carotid ultrasound, an educational tutorial on atherosclerosis, baseline and 2-month motivation to change assessment, and assessment of smoking cessation at 2 months. Participants had a mean smoking duration of 34 years (SD=7). Carotid plaques were present in 22 smokers (73%). Between baseline and 2 months after plaque screening, motivation for smoking cessation increased from 7.4 to 8.4 out of 10 (p=.02), particularly in those with plaques (7.2 to 8.7, p=.008). At 2 months, the smoking quit rate was 63%, with a quit rate of 73% in those with plaques vs. 38% in those without plaques (p=.10). Perceived stress, anxiety, and depression did not increase after screening. 96% of respondents answered correctly at least 80% of questions regarding atherosclerosis knowledge at baseline and after 2 months. In conclusion, studying the process of screening for carotid plaques for the purpose of increasing motivation for smoking cessation, in addition to counseling and drug therapy for smoking cessation in long-term smokers, appears feasible. The impact of carotid plaque screening on smoking cessation should be examined in larger randomized controlled trials with sufficient power to assess the impact on long-term smoking cessation rates.

Ruffoli R; Soldani P; Pasquali L; Ruggieri S; Paparelli A; Fornai F. Methamphetamine fails to alter the noradrenergic integrity of the heart: A comparison with the Parkinsonism-inducing neurotoxin MPTP. Annals of the the New York Academy of Sciences. Drug Addiction: Research Frontiers and and Treatment Advances 1139: 337-344, 2008. (63 refs.)

The chronic use of methamphetamine leads to cardiomyopathy and a nigrostriatal dopamine deficiency that partly mimics what occurs in Parkinson's disease. This study examines the cardiac effects occurring after chronic administration of methamphetamine and parkinsonism-inducing neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Despite the similarities concerning the nigrostriatal dopamine denervation, methamphetamine failed to produce chronic norepinephrine depletion in the heart, thus contrasting with what occurs in Parkinson's disease or after administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. These data suggest that the chronic cardiovascular effects induced by methamphetamine rely on biochemical changes which differ from those activated by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine or during the course of Parkinson's disease.

Sadeghian S; Darvish S; Shahbazi S; Mahmoodian M. Two ecstasy-induced myocardial Infarctions during a three month period in a young man. Archives of Iranian Medicine 10(3): 409-412, 2007. (14 refs.)

Ecstasy normally contains 3,4 methylenedioxymethamphetamine (MDMA) that increases the levels of serotonin, dopamine, and epinephrine in the central nervous system with consequent adverse effects on the cardiovascular system. Herein, we presented a case of ecstasy abuse which resulted in two episodes myocardial infarction during a three month period; the second episode led to death due to thrombus formation.

Sneider JT; Pope HG; Silveri MM; Simpson NS; Gruber SA; Yurgelun-Todd DA. Differences in regional blood volume during a 28-day period of abstinence in chronic cannabis smokers. European Neuropsychopharmacology 18(8): 612-619, 2008. (46 refs.)

Cerebral blood volume (CBV) studies have provided important insight into the effects of illicit substances such as cannabis. The present study examined changes in regional blood volume in the frontal and temporal lobe, and the cerebellum during 28 days of supervised abstinence from cannabis. Dynamic susceptibility contrast MRI (DSCMRI) data were collected on 15 current, long-term cannabis users between 6 and 36 h after the subjects' last reported cannabis use (Day 0), and again after 7 and 28 days of abstinence. Resting state CBV images were also acquired on 17 healthy comparison subjects. The present findings demonstrate that at Day 7, cannabis users continued to display increased blood volumes in the right frontal region, the left and right temporal regions, and the cerebellum. However, after 28 days of abstinence, only the left temporal area and cerebellum showed significantly increased CBV values in cannabis users. These findings suggest that while CBV levels begin to normalize with continued abstinence from cannabis, specifically in frontal areas, other temporal and cerebellar brain regions show slower CBV decreases.

Sohn M; Benowitz N; Stotts N; Christopherson D; Kim KS; Jang YS et al. Smoking behavior in men hospitalized with cardiovascular disease in Korea: A cross-sectional descriptive study. Heart & Lung 37(5): 366-379, 2008. (71 refs.)

OBJECTIVE: Korean men have the highest rate of smoking in the world, and cardiovascular disease (CVD) is the second leading cause of death in this Population. The study's objective was to describe factors related to smoking behavior in men hospitalized with CVD in Korea. METHODS: In collecting data for this cross-sectional Study, a structured questionnaire was administered using a guided interview and medical record abstraction. RESULTS: The Study sample included 97 men with a mean age of 54.1 (+/- 9.6) years. Most of the men were married (85.6%) and employed (79.4%), and had graduated from high school or higher levels of education (74.2%). Sixty-five percent of the men were addicted to nicotine. Lower education (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.01-10.14), starting to smoke at an early age (OR: 3.30, 95% CI: 1.14-9.50), and smoking more cigarettes per day (OR: 9.71, 95% CI: 2.31-40.90) were statistically significant independent predictors of their level of addiction. Twenty-two percent of the men smoked during their hospitalization, a behavior that was significantly associated only with their intention to quit smoking (OR:.09, 95% CI:.03-.31). CONCLUSION: This was the first study to investigate smoking behavior in men hospitalized with CVD in Korea. its findings strongly suggest that smoking-cessation intervention is needed in this population and that Korean health care providers must be properly educated and trained to provide this service.

Soraisham AS; Elliott D; Amin H. Effect of single loading dose of intravenous caffeine infusion on superior mesenteric artery blood flow velocities in preterm infants. Journal of Paediatrics and Child Health 44(3): 119-121, 2008. (20 refs.)

Aim: To evaluate the effects of a single loading dose of caffeine base (10 mg/kg) on superior mesenteric artery (SMA) blood flow velocities (BFV). Methods: Eighteen preterm infants of gestational age <= 32 weeks gestation were investigated prospectively. SMA BFV before infusion, 1 h, 2 h and 6 h after a single loading dose of caffeine were measured using Doppler ultrasonography. Results: The peak systolic velocity in SMA decreased by 18% from baseline at 1 h after caffeine infusion and improved towards the baseline by 6 h after the infusion. The reduction in velocity after caffeine infusion was not statistically significant. No significant changes were observed in heart rate, blood pressure and incidence of necrotising enterocolitis. Conclusion: A single 10 mg/kg intravenous loading dose of caffeine does not cause a significant reduction in SMA BFV and therefore does not place the preterm intestine at increased risk of ischemic injury.

Stafford L; Jackson HJ; Berk M. Illness beliefs about heart disease and adherence to secondary prevention regimens. Psychosomatic Medicine 70(8): 942-948, 2008. (68 refs.)

Objective: We investigated illness beliefs of recently hospitalized patients with coronary artery disease (CAD) and the prospective association between these beliefs and adherence to secondary prevention behaviors. Causal attributions of CAD and their concordance with actual patient risk profiles were also examined. Method: A prospective study of 193 patients was conducted. Data were collected by self-report and from medical records at 3, 6, and 9 months after discharge. Baseline depression was assessed by structured clinical interview. The association between illness beliefs and adherence was tested with hierarchical linear regression controlling for clinical and demographic confounders. Results: Most participants perceived high personal and treatment control and believed CAD to be chronic in duration with severe consequences. A relatively low number of symptoms were endorsed as being part of CAD. Heredity was considered the single most important and most commonly perceived cause of CAD. Smoking, alcohol, emotional state, and heredity were significantly more likely to be endorsed as causal factors by respondents with these risk profiles. In multivariate analysis, illness belief, contributed an additional 6% of the total variance explained by the model (P =.02). Perceptions of more serious consequences predicted better adherence (p =.03). Social desirability was the best single predictor of adherence. Conclusion: Patient perceptions of risk factors were largely consistent with actual risk factors. Despite modest effect sizes, illness beliefs do contribute to our understanding of adherence to secondary prevention behavior. Interventions aimed at modifying these beliefs, particularly those related to the consequences of CAD, may improve patient outcomes.

Stoner L; Sabatier MJ; Black CD; McCully KK. Occasional cigarette smoking chronically affects arterial function. Ultrasound in Medicine and Biology 34(12): 1885-1892, 2008. (33 refs.)

Cigarette smoking is associated with impaired arterial function as measured by reduced vasodilation in response to reactive hyperemia. However, previous studies did not account for potential differences in shear stimuli. The purpose of this study was to use voting, occasional smokers to ethically evaluate effects of acute and chronic smoking on shear rate-diameter dose-response slopes. Young (20 to 26-y-old) nonsmokers (n = 9) and occasional (<1 pack/week) smokers were tested (n = 9). Smokers were tested after abstaining for 2 or more d and then immediately after smoking two cigarettes. Shear rate was manipulated using five upstream ischemic durations (0.5, 1, 2, 5 and 10 min). Radial artery blood velocities and diameters were assessed using Doppler ultrasound. Hierarchical linear modeling (HLM) was used to estimate change in diameter using repeated measures of shear rate nested within each subject. The shear rate-diameter slope was reduced by 35.9% in occasional smokers compared with nonsmoking controls (beta = 2.78(10-4) versus 1.78(10-4), p = 0.004). Acute smoking further attenuated the shear rate-diameter slope (i.e., arterial function) by 23.8% (beta = 1.79(10-4) versus 1.36(10-4), P = 0.037). These results suggest that repeated bouts of occasional cigarette smoking can chronically attenuate arterial function in otherwise healthy, young persons.

Strasak AM; Kelleher CC; Klenk J; Brant LJ; Ruttmann E; Rapp K et al. Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality: A prospective population-based study in 76,113 Austrian adults. Arteriosclerosis, Thrombosis, and Vascular Biology 28(10): 1857-1865, 2008. (45 refs.)

Objective: The purpose of this study was to investigate the association of longitudinal change in serum gamma-glutamyltransferase (GGT) with mortality from cardiovascular disease (CVD). Methods and Results: A population-based cohort of 76 113 Austrian men and women with 455 331 serial GGT measurements was prospectively followed-up for a median of 10.2 years after assessment of longitudinal GGT change during an average period of 6.9 years. Cox proportional hazards regression with time-varying covariates was used to evaluate GGT change as an independent predictor for CVD death. Independently of baseline GGT and other classical CVD risk factors, a pronounced increase in GGT (7-year change > 9.2 U/ L) was significantly associated with increased total CVD mortality in men (P = 0.005); the adjusted hazard ratio (95% confidence interval) in comparison to stable GGT (7-year change -0.7 to 1.3 U/L) was 1.40 (1.09 to 1.81). Similarly, total CVD risk was elevated for increasing GGT in women, although effects were less pronounced and statistically significant only in subanalyses regarding coronary heart disease. Age of participants significantly modified the relation between GGT change and CVD mortality, with markedly stronger associations to be observable for younger individuals. Conclusion -Our study is the first to demonstrate that a longitudinal increase in GGT, independently of baseline GGT and even within its normal range, significantly increases risk of fatal CVD.

Strayer RJ; Nelson LS. Adverse events associated with ketamine for procedural sedation in adults. (review). American Journal of Emergency Medicine 26(9): 985-1028, 2008. (177 refs.)

Study Objectives: Ketamine is widely used as a procedural sedation agent in pediatrics, where its safety and efficacy are supported by numerous studies. Emergency physicians use ketamine infrequently in adults, as it is believed to have a more significant side effect profile in this population. However, adult data on ketamine use in the emergency medicine literature are sparse. Our objective was to determine ketamine's adverse effect profile in adults when used for procedural sedation. Methods: We performed a literature review based on adverse effect research methodology recommendations. PubMedicine, EMBASE, TOXNET, and a variety of specialized databases were queried without regard to publication date or language. Experts were contacted to locate additional data. Inclusion criteria included adult study; ketamine used to facilitate the performance of painful procedures; dose of at least 1 mg/kg intravenous or at least 2 mg/kg intramuscular; original data and adverse events reported; spontaneously breathing patient, and no continuous cotherapies. Studies that met inclusion criteria were abstracted onto structured forms and their results qualitatively summarized. Results: Of the 5512 unique citations that were evaluated, 87 met criteria for inclusion. Most studies were performed in the 1970s and published in the anesthesia literature. Contexts, end points, and methodological quality varied widely across studies. Ketamine reliably produces conditions that facilitate the performance of painful procedures. Pharyngeal reflexes are generally preserved and cardiovascular tone stimulated, including a rise in blood pressure and myocardial oxygen demand. Laryngospasm and airway obstruction are reported, and though ketamine is a respiratory stimulant, a brief period of apnea around the time of injection is common. Reports of significant cardiorespiratory adverse events are rare, despite ketamine's frequent use in austere, poorly monitored settings. Dysphoric emergence phenomena occur in 10% to 20% of cases; sedating medications are effective in preventing and managing these reactions. Conclusion: When ketamine is used for procedural sedation in adults, emergence phenomena occur in 10% to 20% of patients. Although providers must be prepared to recognize and manage airway obstruction, cardiorespiratory adverse events are rare and typically do not affect outcomes.

Syed RH; Moore TL. Methylphenidate and dextroamphetamine-induced peripheral vasculopathy. Journal of Clinical Rheumatology 14(1): 30-33, 2008. (12 refs.)

Methylphenidate and dextroamphetamine are central nervous system stimulants used in the treatment of attention deficit hyperactivity disorders in children. These medications have been associated with cerebral arteritis, renal necrotizing vasculitis, and systemic and pulmonary hypertension. We report 4 patients, 2 on methylphenidate and 2 on dextroamphetamine who presented with acral cyanosis, livedo reticularis, or Raynaud phenomenon. Two patients were found to have a positive ANA at low titers, 1 of whom had histopathologic evidence of stratum malgiphian necrosis with perivascular lymphocytic infiltration on skin biopsy. Two had positive antihistone antibodies. One patient improved after withdrawal of dextroamphetamine; others had worsening of their symptoms on higher doses of medications. These cases indicate the potential for development of acral cyanosis, livedo reticularis, or Raynaud symptoms with these medications and their potential contribution to a vasculopathy.

Takefuji S; Yatsuya H; Tamakoshi K; Otsuka R; Wada K; Matsushita K et al. Smoking status and adiponectin in healthy Japanese men and women. Preventive Medicine 45(6): 471-475, 2007. (35 refs.)

Background. Recent studies promisingly indicate that adiponectin plays an important and fundamental role in the development and progression of metabolic and atherosclerosis disorders. Smoking is known as one of the most important risk factors of atherosclerosis, and its relation with metabolic disorders has also been reported. We therefore investigated the association between cigarette smoking and adiponectin concentration in a large sample of Japanese men and women. Method. The cross-sectional study was carried out in 2002. The subjects were 3260 men and 953 women local government workers aged 35 to 59 in Japan. Lifestyle-related variables including detailed smoking history were inquired in a self-administered questionnaire. Results. Significant differences in adiponectin levels related to smoking status were observed in both men and women (p=0.001). A dose-dependent association was found between the intensity of smoking and adiponectin levels in current smokers, and was statistically significant in men (p for trend=0.006 in the multivariate-adjusted model). Men who quit smoking for more than 20 years and women for more than 10 years had an adiponectin concentration similar to that observed in non-smokers. Conclusion. We not only revealed that current smoking habit was associated with low adiponectin level but also found a dose-dependent association between smoking intensity and adiponectin level in current smokers. The present finding may provide further evidence of the importance of a causal relationship between smoking status and adiponectin concentrations.

Thorgeirsson TE; Geller F; Sulem P; Rafnar T; Wiste A; Magnusson KP et al. A variant associated with nicotine dependence, lung cancer and peripheral arterial disease. Nature 452(7187): 638-U9, 2008. (39 refs.)

Smoking is a leading cause of preventable death, causing about 5 million premature deaths worldwide each year. Evidence for genetic influence on smoking behaviour and nicotine dependence (ND)(3-8) has prompted a search for susceptibility genes. Furthermore, assessing the impact of sequence variants on smoking-related diseases is important to public health. Smoking is the major risk factor for lung cancer (LC) and is one of the main risk factors for peripheral arterial disease (PAD). Here we identify a common variant in the nicotinic acetylcholine receptor gene cluster on chromosome 15q24 with an effect on smoking quantity, ND and the risk of two smoking- related diseases in populations of European descent. The variant has an effect on the number of cigarettes smoked per day in our sample of smokers. The same variant was associated with ND in a previous genomewide association study that used low- quantity smokers as controls, and with a similar approach we observe a highly significant association with ND. A comparison of cases of LC and PAD with population controls each showed that the variant confers risk of LC and PAD. The findings provide a case study of a gene - environment interaction, highlighting the role of nicotine addiction in the pathology of other serious diseases.

Topp L; Iversen J; Conroy A; Salmon AM; Maher L. Prevalence and predictors of injecting-related injury and disease among clients of Australia's needle and syringe programs. Australian and New Zealand Journal of Public Health 32(1): 34-37, 2008. (24 refs.)

Objective: To identify lifetime prevalence and predictors of self-reported injecting-related injuries and diseases (IRID) and/or injecting-related problems (IRP) among a national cross-sectional sample of injecting drug users. Methods: 1,961 clients of 45 needle and syringe programs (NSPs) who participated in the 2006 Australian NSP Survey self-completed an item regarding lifetime experience of eight separate IRIDs and IRPs. Results: Sixty-nine per cent of participants reported a history of IRID/IRP, with a mean of 1.9 injuries/problems (range 0-8). Lifetime prevalence of specific injuries/problems ranged from problems finding a vein (43%) to endocarditis (4%). Factors independently associated with IRID/IRP included bisexual identity; daily or more frequent injecting; injection of pharmaceutical preparations; female gender; longer injecting history; and hepatitis C antibody-positive serostatus. Conclusions: Consistent with existing literature, results suggest that vascular injury and localised infections are common among IDUs; and that treatment-seeking is often delayed until serious complications arise. Implications: Findings support the imperative for co-ordinated and timely treatment and prevention activities to reduce the severity and burden of these prevalent injecting outcomes.

Tripathi M; Pandey M; Singh U; Dwivedi S. Non-smokers are more prone to pulmonary oedema than smokers during acute coronary syndrome. International Journal of Clinical Practice 62(12): 1880-1885, 2008. (31 refs.)

Acute coronary syndrome (ACS) patients are prone to develop pulmonary oedema with varied degree of hypoxaemia. The aim was to compare the risk for pulmonary oedema and related complications during ACS amongst non-smokers vs. smokers. Prospective, observational study was performed in consecutive 68 patients presenting with ACS. They were divided into two groups; group 1 (n = 33) non-smokers and group 2 (n = 35) chronic smokers. Standard conservative treatment was given to maintain mean arterial pressure >= 60 mmHg, oxygen saturation > 95%. The bedside chest x-ray was graded for Battler grading (0-4) for pulmonary oedema. All patients were evaluated for troponin, serial creatinine kinase, echocardiography, arterial blood gas, renal function and correlated with inotropes requirement, active respiratory support, coronary care unit (CCU) stay and hospital outcome. Patients in both the groups had similar cardiac involvement for cardiothoracic ratio, troponin, ejection fraction and creatinine kinase muscle and brain (CK-MB). The bedside chest x-ray revealed significant (p < 0.05) lung oedema grades (3 and 4) in 60% non-smokers (group 1) vs. smokers (11%). These patients (group 1) also presented with significant (p < 0.001) hypoxaemia (lower PaO2/FiO(2)-201 +/- 44), metabolic acidosis (higher lactate; 2.1 +/- 0.72 mmol/l, base deficit; -5.1 +/- 4.8) and hypocarbia (28 +/- 2.9 mmHg) than smokers (group 2). The risk estimates for active respiratory support (OR =1.716) and inotrope use (OR = 1.836) was three times higher in non-smokers than smokers. The higher degree of pulmonary oedema and hypoxemia probably contributed to poor short-term outcome in non-smokers than smokers. It would be important to recognise and treat hypoxaemia in non-smokers during ACS.

Trockel M; Burg M; Jaffe A; Barbour K; Taylor CB. Smoking behavior post-myocardial infarction among ENRICHD trial participants: Cognitive behavior therapy intervention for depression and low perceived social support compared with care as usual. Psychosomatic Medicine 70(8): 875-882, 2008. (43 refs.)

Introduction: Patients with cardiovascular disease who stop smoking lower their risk of subsequent morbidity and mortality. However, patients who have suffered a myocardial infarction (MI) are more likely to be depressed than the general population, which may make smoking cessation more difficult. Poor social support may also make smoking cessation more difficult for some patients. This study examines the effect of cognitive behavior therapy (CBT) for depression, low perceived social support or both on smoking behavior in post-MI patients. Methods: Participants were 1233 patients with a history of smoking enrolled in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) trial who provided 7-day point-prevalence smoking behavior information at baseline and at two or more follow-up assessments. The ENRICHD trial enrolled post-Ml patients with depression, low perceived social support or both. Participants were randomly assigned to either CBT intervention or usual care. We used mixed effects models to accommodate data from multiple smoking point-prevalence measures for each individual participant. Results: CBT did not significantly reduce post-MI smoking across all intervention patients with a history of smoking. However, CBT did reduce post-Ml smoking among the subgroup of depressed patients with adequate perceived social support (OR, 0.68; 95% Cl, 0.47-0.98). Conclusion: CBT for depression without more specific attention to smoking cessation may have little overall value as a strategy for helping post-Ml patients refrain from smoking. However, use of CBT to treat depression may have the gratuitous benefit of reducing smoking among some post-Ml patients.

Tseng CH. Betel nut chewing is associated with hypertension in Taiwanese type 2 diabetic patients. Hypertension Research 31(3): 417-423, 2008. (44 refs.)

Betel nut chewing is associated with oral cancers and diabetes. This study investigated whether betel nut chewing could be associated with hypertension in Taiwanese patients with type 2 diabetes mellitus (T2DM). The data of a total of 81,226 (37,226 men and 44,000 women) patients with T2DM obtained from a cross-sectional telephone survey in a national sample of diabetic patients in Taiwan were analyzed. Hypertension was defined by a positive history or reported systolic blood pressure >= 140 mmHg and/or diastolic blood pressure ?:90 mmHg. Analyses were performed in separate sexes with consideration paid to the potential confounding effects of age, diabetic duration, body mass index and smoking. The prevalences of betel nut chewing in men and women were 20.4% and 1.1%, respectively. Betel nut chewing was more common in the younger age groups of the male sex. The multivariate-adjusted odds ratios for hypertension in chewers vs. non-chewers were 1.067 (1.007-1.131) and 1.897 (1.534-2.346) for men and women, respectively. In multiple linear regression, although no adjustment was made for the use of antihypertensive agents, betel nut chewing was significantly associated with blood pressure, with regression coefficients of 0.958 +/- 0.163 (SEM) for systolic and 0.441 +/- 0.108 for diastolic blood pressure in men; and the respective values for women were 1.805 +/- 0.618 and 1.198 +/- 0.393. In conclusion, betel nut chewing was significantly associated with hypertension in Taiwanese patients with T2DM and the association was stronger in women.

Tuan TC; Chang SL; Tai CT; Lin YJ; Hu YF; Lo LW et al. Impairment of the atrial substrates by chronic cigarette smoking in patients with atrial fibrillation. Journal of Cardiovascular Electophysiology 19(3): 259-265, 2008. (28 refs.)

Smoking, Voltage, and Atrial Fibrillation. Background: Smoking is a major risk factor for cardiovascular disease. The impact of smoking on the right and left atrial substrates is unknown. Methods: This study included 88 patients (age 50 +/- 13 years, M/F = 71/17) who underwent four pulmonary veins isolation (PVI) for paroxysmal atrial fibrillation (AF). The mean voltage and total activation time of the individual atria were obtained by using a NavX mapping system, and were compared between the patients with and without a previous smoking history. The dose effect was evaluated by the smoking intensity-duration, defined as the number of packs per day plus how many years they had been smoking. Results: The right atrial (RA) mean voltage was lower in the patients with a previous history of smoking than in those without a history of smoking (1.92 +/- 0.49 vs 2.17 +/- 0.56 mV, P < 0.05). The left atrial (LA) mean voltage was similar between the two groups (1.73 +/- 0.67 vs 1.82 +/- 0.48 mV, P = 0.488). Further, the total activation time of the RA was longer in the patients with a previous history of smoking than in those without a history of smoking, but not so for the LA. Furthermore, the voltage reduction in the RA was related to the smoking intensity-duration (Pearson's correlation, r = 0.650, P < 0.001). Conclusions: In patients with atrial fibrillation, the RA mean voltage and total activation time were significantly correlated to smoking and had a dose-dependent effect.

van Dam RM. Coffee consumption and coronary heart disease: Paradoxical effects on biological risk factors versus disease incidence. (editorial). Clinical Chemistry 54(9): 1418-1420, 2008. (28 refs.)

van Dam RM. Coffee consumption and risk of type 2 diabetes, cardiovascular diseases, and cancer. Applied Physiology, Nutrition and Metabolism 33(6): 1269-1283, 2008. (109 refs.)

Numerous epidemiological studies have evaluated the association between coffee consumption and risk of type 2 diabetes, coronary heart disease, and various cancers. This paper briefly reviews the evidence for a relation between coffee consumption and these conditions, with particular attention to methodological issues. Several early studies suggested that coffee consumption could result in a marked increase in risk of coronary heart disease and several types of cancer. However, more recent prospective cohort studies that are less prone to selection and information bias have not confirmed these findings. High consumption of unfiltered types of coffee, such as French press and boiled coffee, has been shown to increase low-density-lipoprotein-cholesterol concentrations. In addition, limiting caffeinated coffee intake during pregnancy seems a prudent choice. However, evidence has been accumulating that frequent consumption of coffee may reduce risk of type 2 diabetes and liver cancer. Further experimental studies are warranted to elucidate the underlying mechanisms and possibly identify the components in coffee that are responsible for these putative effects. In sum, the currently available evidence on coffee and risk of cardiovascular diseases and cancer is largely reassuring, and suggests that, for the general population, addressing other health-related behaviors has priority for the prevention of chronic diseases.

Wallner C; Stollberger C; Hlavin A; Finsterer J; Hager I; Hermann P et al. Electrocardiographic abnormalities in opiate addicts. Addiction 103(12): 1987-1993, 2008. (29 refs.)

To determine in a cross-sectional study the prevalence of electrocardiographic (ECG) abnormalities in opiate addicts who were therapy-seeking and its association with demographic, clinical and drug-specific parameters. In consecutive therapy-seeking opiate addicts, a 12-lead ECG was registered within 24 hours after admission and evaluated according to a pre-set protocol between October 2004 and August 2006. Additionally, demographic, clinical and drug-specific parameters were recorded. Included were 511 opiate-addicts, 25% female, with a mean age of 29 years (range 17-59 years). One or more ECG abnormalities were found in 314 patients (61%). In the 511 patients we found most commonly ST abnormalities (19%), QTc prolongation (13%), tall R- and/or S-waves (11%) and missing R progression (10%). ECG abnormalities were more common in males than in females (64 versus 54%, P < 0.05), and in patients with positive than negative urine findings for cannabis (68 versus 57%, P < 0.05). Patients with ST abnormalities were more often males than females (21 versus 11%, P < 0.05), had a history of seizures less often (16 versus 27%, P < 0.05), had positive than negative urine findings for cannabis more often (26 versus 15%, P < 0.01) and had negative than positive urine findings for methadone more often (21 versus 11%, P < 0.05). QTc prolongation was more frequent in patients with high dosages of maintenance drugs than in patients with medium or low dosages (27 versus 12 versus 10%, P < 0.05) and in patients whose urine findings were positive than negative for methadone (23 versus 11%, P < 0.001) as well as for benzodiazepines (17 versus 9%, P < 0.05). Limitations of the data are that in most cases other risk factors for the cardiac abnormalities were not known. ECG abnormalities are frequent in opiate addicts. The most frequent ECG abnormalities are ST abnormalities, QTc prolongation and tall R- and/or S-waves. ST abnormalities are associated with cannabis, and QTc prolongation with methadone and benzodiazepines.

Westover AN; Nakonezny PA; Haley RW. Acute myocardial infarction in young adults who abuse amphetamines. Drug and Alcohol Dependence 96(1-2): 49-56, 2008. (44 refs.)

Background: Case reports suggest a link between methamphetamine abuse and acute myocardial infarction (AMI), but no epidemiologic studies have examined this link. Our objective was to test the hypothesis that young adults who abuse amphetamines are at higher risk for AMI. Methods: In this study of 3,148,165 discharges from Texas hospitals in a quality indicators database during 2000-2003, among persons aged 18-44 years we identified 11,011 AMIs, defined according to the Agency for Healthcare Research and Quality's AMI mortality inpatient quality indicator. Results: In a multiple logistic regression analysis-while controlling for cocaine abuse, alcohol abuse, tobacco use, hypertension, diabetes mellitus, lipid disorders, obesity, congenital defects, and coagulation defects - amphetamine abuse was significantly associated with AMI (adjusted odds ratio = 1.61; 95% CI = 1.24-2.04, p = 0.0004). The rate of AMIs among amphetamine abusers increased significantly from 2000 to 2003. The population attributable risk suggests that amphetamine abuse is responsible for 0.2% of AMIs in the state of Texas. The geographical distribution of amphetamine abuse varied by region, with the prevalence being highest in the North Texas and Panhandle regions of Texas. Conclusions: This modest, though statistically robust, association suggests that amphetamine abuse may play a role in AMI.

Wiklund U; Karlsson M; Otrom M; Messner T. Influence of energy drinks and alcohol on post-exercise heart rate recovery and heart rate variability. Clinical Physiology and Functional Imaging 29(1): 74-80, 2009. (28 refs.)

Media have anecdotally reported that drinking energy drinks in combination with alcohol and exercise could cause sudden cardiac death. This study investigated changes in the electrocardiogram (ECG) and heart rate variability after intake of an energy drink, taken in combination with alcohol and exercise. Ten healthy volunteers (five men and five women aged 19-30) performed maximal bicycle ergometer exercise for 30 min after: (i) intake of 0.75 l of an energy drink mixed with alcohol; (ii) intake of energy drink; and, (iii) no intake of any drink. ECG was continuously recorded for analysis of heart rate variability and heart rate recovery. No subject developed any clinically significant arrhythmias. Post-exercise recovery in heart rate and heart rate variability was slower after the subjects consumed energy drink and alcohol before exercise, than after exercise alone. The healthy subjects developed blunted cardiac autonomic modulation after exercising when they had consumed energy drinks mixed with alcohol. Although they did not develop any significant arrhythmia, individuals predisposed to arrhythmia by congenital or other rhythm disorders could have an increased risk for malignant cardiac arrhythmia in similar situations.

Wright NMJ; Martin M; Goff T; Morgan J; Elworthy R; Ghoneim S. Cocaine and thrombosis: a narrative systematic review of clinical and in-vivo studies. Substance Abuse Treatment, Prevention, and Policy 2(e-article 27), 2007. (50 refs.)

Purpose: To systematically review the literature pertaining to the link between cocaine and either arterial or venous thrombosis. Procedures: Narrative systematic review of Medline, CINAHL, Embase, Psycinfo and Cochrane databases supplemented by hand trawling of relevant journals and reference lists up to April 2007. In-vivo studies and those with clinical endpoints were included in the review. Results: A total of 2458 abstracts led to 186 full-text papers being retrieved. 15 met the criteria for inclusion in the review. The weight of evidence would support cocaine as a pro-thrombotic agent. There is evidence of it activating thrombotic pathways. The effect of cocaine upon clinical endpoints has not been quantified though there is evidence of an association between cocaine and myocardial infarction particularly amongst young adults. Cocaine may also be a causal agent in cerebrovascular accident though studies lacked sufficient power to determine a statistically significant effect. There is a gap in the evidence pertaining to the issue of cocaine and venous thrombosis. Conclusion: Clinicians should consider questioning for cocaine use particularly amongst young adults who present with cardiac symptoms. More epidemiological work is required to quantify the effect of cocaine upon both arterial and venous clotting mechanisms.

Wryobeck JM; Walton MA; Curran GM; Massey LS; Booth BM. Complexities of cocaine users presenting to the emergency department with chest pain: Interactions between depression symptoms, alcohol use, and race. Journal of Addiction Medicine 1(4): 213-221, 2007. (55 refs.)

Chest pain is the most frequent cocaine-related medical event for which patients seek treatment in inner-city emergency departments (EDs). Given that depression increases risk for poor substance use and cardiac outcomes, knowledge of correlates of depressive symptoms among these out-of-treatment cocaine users is crucial to developing interventions for these inner-city populations that frequently present to the ED. A total of 219 individuals presenting to an inner-city ED with chest pain and recent cocaine use were divided into 2 groups based on scoring positive (42%) for moderate-to-severe depression on the Patient Health Questionnaire (PHQ-9). The depression symptoms group reported a significantly greater number of standard drinks per drinking occasion (7.1 versus 4.6) and a greater number of heavy drinking days (9 versus 5). A significant 3-way interaction effect found males and non-white females reporting a greater number of heavy drinking days were more likely to be in the depression symptoms group, whereas white females with a greater number of heavy drinking days were more likely to be in the nondepression symptoms group. Depression is clearly a problem among not-in-treatment cocaine users presenting to an inner-city ED; heavy drinking in concert with cocaine use increases the risk for depression, with important interactions by race and gender.

Yamamoto RT; Teter CJ; Barros TL; McCarthy E; Mileti C; Juliano T et al. Antiandrogen pretreatment alters cocaine pharmacokinetics in men. Journal of Addiction Medicine 1(4): 198-204, 2007

Among cocaine users, men experience more adverse brain and vascular effects than their female counterparts. This could be caused by testosterone, which may potentiate some of cocaine's effects. We examined whether antiandrogen (flutamide, FL) pretreatment alters cocaine's acute behavioral, physiologic, and pharmacokinetic effects in men with histories of occasional cocaine use. Participants (N = 8) were pretreated with oral FL (250 mg) and placebo on separate study days followed by intravenous (IV) cocaine (0.4 mg/kg). Vital signs, subjective ratings, and blood samples for cocaine and metabolites were obtained at baseline and for 90 minutes after cocaine administration. FL, itself, had no effects on physiologic or subjective responses; however, after cocaine, heart rate recovered faster with FL pretreatment. Flutamide reduced peak plasma cocaine levels (Wilcoxon signed-rank z = 2.1, P < 0.04) and area under the curve (AUC; z = 1.96, P < 0.05). Additionally, FL reduced EME levels (z = 1.96, P < 0.05) and AUC for BE and EME (z = 2.38, P < 0.02 and z = 1.96, P < 0.05, respectively). These results suggest that FL may alter cocaine pharmacokinetics in men. Because cocaine and BE are vasoconstrictive, the data imply that FL might reduce some of cocaine's cardiovascular effects.

Yufu K; Takahashi N; Okada N; Shinohara T; Hara M; Saikawa T et al. Influence of systolic blood pressure and cigarette smoking on endothelial function in young healthy people. Circulation Journal 73(1): 174-178, 2009. (27 refs.)

Background: Flow-mediated dilatation (FMD) of the brachial artery represents systemic endothelial function, the relationship between FMD and blood pressure (BP) profile. in relation to the effects of cigarette smoking, was investigated in young healthy subjects. Methods and Results The 62 healthy Subjects (14 females, 48 males; mean 29.7 +/- 5.5 years old), were divided into a smoking group (n=30) and non-smoking group (n=32). FMD was induced by reactive hyperemia. It was lower in the smoking group than in the non-smoking group (P<0.05). In the non-smoking group, there was an inverse correlation (r=-0.59, P<0.0005) between FMD and systolic BP (SBP), which was not recognized in the smoking group. Multiple stepwise regression analysis revealed that FMD was predicted by either the SBP or the brachial artery diameter in the non-smoking group, whereas it was predicted by the brachial artery diameter in the smoking group. Subdivision by cut-off value of SBP=120 mmHg demonstrated that although FMD with SBP<120mmHg was preserved in subjects in the non-smoking group, it was depressed to a level comparable with SBP >= 120 mmHg in the smoking group. Conclusions: Highly-preserved FMD in subjects with SBP<120 mmHg appears to be impaired by cigarette smoking, resulting in a loss of association between FMD and SBP.