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CORK Bibliography: Drugs and the Cardiovascular System

86 citations. January 2010 to present

Prepared: March 2011

Aboyans V; Thomas D; Lacroix P. The cardiologist and smoking cessation. (review). Current Opinion In Cardiology 22(5): 469-477, 2010. (61 refs.)

Purpose of review: Among the modifiable risk factors, smoking contributes strongly to the global epidemics of cardiovascular disease morbidity and mortality. In patients with cardiovascular disease, the benefits of smoking cessation outperform those expected from other preventive strategies such as blood pressure or cholesterol control. In-hospital interventions to assist cardiovascular disease patients with smoking cessation and to provide adequate follow-up are the most cost-effective strategies to improve the survival of the cardiovascular patient. Recent findings: Data on cardiologists' interest in increasing smoking cessation rates are limited and alarming. Surveys assessing the knowledge, interest and attitudes of cardiologists regarding smoking cessation assistance highlight poor commitment to this important preventive practice. For a substantial proportion of cardiologists, smoking-cessation assistance is not included in their core activities and they do not consider themselves as the most appropriate person for this purpose. Disappointingly, many of them never refer their smoking patients to specialized centers and/or teams for appropriate assistance. Summary: The substantial benefits of smoking cessation in cardiovascular prevention requires stronger commitment from cardiologists to provide smoking-cessation therapies and counseling. Further research is needed to highlight the barriers to improve clinical performance by cardiologists in this field of prevention.

Ali WM; Zubaid M; Al-Motarreb A; Singh R; Al-Shereiqi SZ; Shehab A et al. Association of khat chewing with increased risk of stroke and death in patients presenting with acute coronary syndrome. Mayo Clinic Proceedings 85(11): 974-980, 2010. (49 refs.)

OBJECTIVE To evaluate the prevalence and significance of khat chewing in patients with acute coronary syndrome (ACS). PATIENTS AND METHODS: From January 29, 2007, through July 29, 2007, 8176 consecutive patients presenting with ACS were en roiled In a prospective, multicenter study from 6 adjacent Middle Eastern countries. RESULTS: Of the 8176 study patients, 7242 (88 6%) were non-khat chewers, and 934 (11 4%) were khat chewers, mainly of Yemeni origin Khat chewers were older (57 vs 56 years, P= 01) and more likely to be men (85 7% vs 74 5%) compared with non khat chewers Non khat chewers were more likely to have diabetes mellitus, hypertension, dyslipldemia, obesity, and prior history of coronary artery disease and revascularization. Cigarette smoking was more prevalent in khat chewers, and they were more likely to present greater than 12 hours after onset of symptoms compared with non-khat chewers. At admission, khat chewers had higher heart rate, Killlp class, and Global Registry of Acute Coronary Events risk scores. Khat chewers had a significantly higher risk of cardiogenic shock, stroke, and mortality After adjustment of baseline variables, khat chewing was an independent risk factor for in hospital mortality (odds ratio, 1 9, 95% confidence interval, 1 3-2 7, P< 001) and stroke (odds ratio, 2 7, 95% confidence interval, 135 9, P= 01). CONCLUSION: in this large cohort of patients with ACS, khat chewing was prevalent and was associated with increased risk of stroke and death in the context of increasing global migration, a greater awareness of potential widespread practices is essential

Anchersen K; Hansteen V; Gossop M; Clausen T; Waal H. Opioid maintenance patients with QTc prolongation: Congenital long QT syndrome mutation may be a contributing risk factor. Drug and Alcohol Dependence 112(3): 216-219, 2010. (16 refs.)

Objectives: This study investigates opioid maintenance treatment (OMT) patients found to have corrected QT (QTc) interval above 500 ms with particular focus on past medical history genetic testing and cardiac investigations Methods: Detailed medical and cardiac history was obtained with particular focus upon risk factors Cardiac investigations including genetic testing for the five most common long QT syndrome (LQTS) mutations exercise electrocardiography (ECG) and 24-h ECG recordings were performed Results Of 200 OMT patients assessed with ECG seven methadone maintained patients identified with QTc interval above 500 ms participated in this study Two were identified as heterozygous LQTS mutation carriers Both had experienced cardiac symptoms prior to and during OMT No other risk factors for QTc prolongation were detected among the seven patients Six of the seven patients underwent further cardiac investigations QTc intervals fluctuated widely over 24h and during exercise for all patients Only one of the LQTS mutation carriers switched to buprenorphine and started on a beta-blocker Despite strong medical advice and information none of the other patients wanted to switch to buprenorphine or take other cardiac protective measures Conclusion: Findings indicate the importance of recording a thorough past medical history focusing specifically on previous cardiac symptoms and on other known risk factors for QTc prolongation prior to initiating patients on methadone.

Armani C; Landini L; Leone A. Interactive effect of cigarette smoking and gene variants for predisposing to cardiovascular disease. (review). Current Pharmaceutical Design 16(23): 2531-2538, 2010. (134 refs.)

Tobacco smoking remains the second largest preventable cause of mortality and morbidity worldwide. Exposure to tobacco smoke causes coronary disease, atherosclerosis and ischaemic vessel disease. The degree of this risk is proportional to the amount of smoking and it varies from individual to individual because of between-individual differences in genetic background. While the chemical properties of tobacco smoke are relatively well characterized, the mechanisms by which smoking leads to disease and the genetic factors that determine susceptibility to these diseases are not well understood. The purpose of the present review is to describe the interacti0on between DNA variants in some important genes and cardiovascular diseases; and how the exposure to cigarette smoke significantly modifies the association between genetic variants and cardiovascular risk. A great number of gene-enzymes that usually protect against cardiovascular events may be adversely influenced by tobacco smoke and, through this way, exert less effective action.

Artin B; Singh M; Richeh C; Jawad E; Arora R; Khosla S. Caffeine-related atrial fibrillation. American Journal of Therapeutics 17(5): E169-E171, 2010. (13 refs.)

We present a case of caffeine-induced atrial fibrillation which spontaneously reverted to normal sinus rhythm. Caffeine is a methylxanthine alkaloid that can cause various supraventricular and ventricular arrhythmias. It is important to improve public awareness of the potential adverse effects of high consumption of caffeine-containing products as fatal and serious events can occur.

Aune E; Endresen K; Roislien J; Hjelmesaeth J; Otterstad JE. The effect of tobacco smoking and treatment strategy on the one-year mortality of patients with acute non-ST-segment elevation myocardial infarction. BMC Cardiovascular Disorders 10: e-article 59, 2010. (19 refs.)

Background: The aim of the present study was to investigate whether a previously shown survival benefit resulting from routine early invasive management of unselected patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) may differ according to smoking status and age. Methods: Post-hoc analysis of a prospective observational cohort study of consecutive patients admitted for NSTEMI in 2003 (conservative strategy cohort [CS]; n = 185) and 2006 (invasive strategy cohort [IS]; n = 200). A strategy for transfer to a high-volume invasive center and routine early invasive management was implemented in 2005. Patients were subdivided into current smokers and non-smokers (including ex-smokers) on admission. Results: The one-year mortality rate of smokers was reduced from 37% in the CS to 6% in the IS (p < 0.001), and from 30% to 23% for non-smokers (p = 0.18). Non-smokers were considerably older than smokers (median age 80 vs. 63 years, p < 0.001). The percentage of smokers who underwent revascularization (angioplasty or coronary artery bypass grafting) within 7 days increased from 9% in the CS to 53% in the IS (p < 0.001). The corresponding numbers for non-smokers were 5% and 27% (p < 0.001). There was no interaction between strategy and age (p = 0.25), as opposed to a significant interaction between strategy and smoking status (p = 0.024). Current smoking was an independent predictor of one-year mortality (hazard ratio 2.61, 95% confidence interval 1.43-4.79, p = 0.002). Conclusions: The treatment effect of an early invasive strategy in unselected patients with NSTEMI was more pronounced among smokers than non-smokers. The benefit for smokers was not entirely explained by differences in baseline confounders, such as their younger age.

Awtry EH; Philippides GJ. Alcoholic and cocaine-associated cardiomyopathies. (review). Progress In Cardiovascular Diseases 52(4): 289-299, 2010. (71 refs.)

Alcohol and cocaine use are associated with significant cardiovascular complications, including cardiomyopathy. The pathophysiologic mechanisms underlying the development of these toxic cardiomyopathies vary depending on the inciting agent but include direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. The typical patient with alcoholic cardiomyopathy is a long-term excessive alcohol consumer who is otherwise indistinguishable from other patients with nonischemic cardiomyopathy. The typical patient with cocaine cardiomyopathy is a young male smoker who presents with signs of adrenergic excess. Management of these patients is similar to that of patients with other forms of dilated cardiomyopathy, although beta-blockers should be avoided in patients with cocaine-associated heart failure and benzodiazepines should be given in this setting to blunt adrenergic excess. Left ventricular function may improve dramatically with abstinence from alcohol or cocaine. Unfortunately, the rate of recidivism is high and left ventricular dysfunction and symptomatic heart failure often recurs.

Baggish AL; Weiner RB; Kanayama G; Hudson JI; Picard MH; Hutter AM et al. Long-term anabolic-androgenic steroid use is associated with left ventricular dysfunction. Circulation. Heart Failure 3(4): 472-U15, 2010. (42 refs.)

Background-Although illicit anabolic-androgenic steroid (AAS) use is widespread, the cardiac effects of long-term AAS use remain inadequately characterized. We compared cardiac parameters in weightlifters reporting long-term AAS use to those in otherwise similar weightlifters without prior AAS exposure. Methods and Results-We performed 2D tissue-Doppler and speckle-tracking echocardiography to assess left ventricular (LV) ejection fraction, LV systolic strain, and conventional indices of diastolic function in long-term AAS users (n=12) and otherwise similar AAS nonusers (n=7). AAS users (median [quartile 1, quartile 3] cumulative lifetime AAS exposure, 468 [169, 520] weeks) closely resembled nonusers in age, prior duration of weightlifting, and current intensity of weight training. LV structural parameters were similar between the two groups; however, AAS users had significantly lower LV ejection fraction (50.6% [48.4, 53.6] versus 59.1% [58.0%, 61.7%]; P=0.003 by two-tailed Wilcoxon rank sum test), longitudinal strain (16.9% [14.0%, 19.0%] versus 21.0% [20.2%, 22.9%]; P=0.004), and radial strain (38.3% [28.5%, 43.7%] versus 50.1% [44.3%, 61.8%]; P=0.02). Ten of the 12 AAS users showed LV ejection fractions below the accepted limit of normal (>= 55%). AAS users also demonstrated decreased diastolic function compared to nonusers as evidenced by a markedly lower early peak tissue velocity (7.4 [6.8, 7.9] cm/s versus 9.9 [8.3, 10.5] cm/s; P=0.005) and early-to-late diastolic filling ratio (0.93 [0.88, 1.39] versus 1.80 [1.48, 2.00]; P=0.003). Conclusions-Cardiac dysfunction in long-term AAS users appears to be more severe than previously reported and may be sufficient to increase the risk of heart failure.

Black JH. Evidence base and strategies for successful smoking cessation. (review). Journal of Vascular Surgery 51(6): 1529-1537, 2010. (85 refs.)

The burden of tobacco dependence can be measured in premature deaths due to accelerated atherosclerotic disease and cancer, and economic costs of lost productivity and intensified medical care. Smoking cessation efforts have benefited from continued pharmacologic developments, increased public awareness of stop-smoking programs, aggressive counter-campaigns to illustrate the toll of cigarette smoking, and recognition of the many primary and secondary effects of smoking exposure on the general public. Vascular surgeons and interventionalists, as well as vascular medicine specialists, are uniquely positioned to engage and educate the patient to promote cessation, monitor for continued abstinence, and assist in efforts to avoid relapses. This article reviews the effects of tobacco dependence on peripheral arterial disease, perioperative considerations in smokers, as well as common clinical interventions such as counseling and pharmacotherapy to encourage tobacco cessation.

Broadley KJ. The vascular effects of trace amines and amphetamines. (review). Pharmacology & Therapeutics 125(3): 363-375, 2010. (185 refs.)

Trace amines, including tyramine, beta-phenylethylamine (beta-PEA), tryptamine and octopamine, are biologically active amines mostly based on phenylethylamine, occurring in the body in trace amounts. They are a diverse group of naturally occurring and synthetic amines, which are also found in the diet and in herbal plants, such as ephedrine and cathinone. They include amphetamine and its analogues, such as MDMA ('ecstasy'), and synthetic proprietary sympathomimetic agents such as phenylpropanolamine and pseudoephedrine. On the vascular system they cause vasoconstriction and a rise in blood pressure. This effect is the basis of their use as nasal decongestants. For over 50 years, they have been assumed to be indirectly acting sympathomimetic amines, their responses being due to the release of noradrenaline from sympathetic neurones. There are, however, results that suggest that this is not their only mechanism of action and that they may also exert direct vascular effects independent of a noradrenergic mechanism. Recently, a group of novel trace amine-associated receptors (TAARs) have been cloned and identified in the brain and peripheral tissues including blood vessels. Trace amines bind to these cloned receptors and it is suggested that their vasoconstrictor effects can in part be attributed to this mechanism. This review describes the cardiovascular pharmacology of this diverse group of amines, their structures and uses and their endogenous synthesis and metabolism. The review also considers their clinical relevance as constituents of the diet, as therapeutic agents (ritodrine, phenylpropanolamine, and pseudoephedrine) and as drugs of abuse (amphetamine, 'ecstasy') and their mechanisms of action.

Brown DW. Smoking prevalence among US veterans. Journal of General Internal Medicine 25(2): 147-149, 2010. (19 refs.)

BACKGROUND/OBJECTIVE: Cigarette smoking is a significant health problem within the US military. Data from the 2003-2007 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate and compare the prevalence of smoking among US veterans with that of adults who did not serve in the US armed forces. METHODS: Data from the BRFSS, a state-based random-digit dialed telephone survey supported by the Centers for Disease Control and Prevention, were used to estimate the prevalence of current smoking among adults (aged >= 18 years) who reported ever serving on active duty in the United States Armed Forces. We compared, by birth cohort, age-adjusted smoking prevalence among veterans with that of adults who did not serve in the military. RESULTS: A total of 224,169 US veterans participated during 2003-2007. The age-adjusted prevalence of smoking during the period was 27.0% (standard error, 0.36) among veterans and 21% (0.12) among non-veterans. For both groups, the prevalence decreased across years from 29% (0.79) in 2003 to 25% (0.82) in 2007 among veterans and from 23% (0.29) in 2003 to 20% (0.26) in 2007 among non-veterans. Among veterans, smoking prevalence was highest among men born between 1975-1984 (36%; 90%CI=33.7-37.5) and those born between 1985-1989 (37%; 90%CI=31.7-48.2) with lower prevalences among men born between 1945-1954 (26%; 90%CI=25.1-26.3), 1955-1964 (33%; 90%CI= 32.3-34.3), and 1965-1974 (27%; 90%CI=26.0-28.1). The prevalence of smoking was 43% (90%CI=39.0-47.6) among veterans with self-reported coronary heart disease (CHD), greater than that for non-veterans with CHD (31%; 90%CI=28.6-33.1). CONCLUSIONS: Although the prevalence of smoking has declined among US adults, there are opportunities to further reduce smoking among US veterans, particularly young veterans for whom the prevalence of smoking is similar to that of the US adult population during the late 1960s/early 1970s. Continued work is necessary to target the high smoking prevalence among veterans with CHD, a group for which smoking cessation is especially important.

Burillo-Putze G; Lopez B; Leon JMB; Sanchez MS; Gonzalez MG; Rodriguez AD et al. Undisclosed cocaine use and chest pain in emergency departments of Spain. Scandinavian Journal of Trauma Resuscitation & Emergency Medicine 17(11), 2009. (17 refs.)

Aims: Illicit cocaine consumption in Spain is one of the highest in Europe. Our objective was to study the incidence of undisclosed cocaine consumption in patients attending in two Spanish Emergency Departments for chest pain. Methods: We analysed urine samples from consenting consecutive patients attending ED for chest pain to determine the presence of cocaine, and other drugs, by semiquantative tests with fluorescence polarization immunoassay (FPIA). Results: Of 140 cases, 15.7 presented positive test for drugs, and cocaine was present in 6.4%. All cocaine-positive patients were younger (p < 0.001); none was admitted to Hospital (p = 0.08). No significant differences in ED stay or need for hospitalization were found between cocaine-positive and negative patients. Conclusion: This finding in chest pain patients who consented to urine analysis suggests that the true incidence of cocaine use leading to such ED visits may be higher.

Buscemi S; Mattina A; Tranchina MR; Verga S. Acute effects of coffee on QT interval in healthy subjects. Nutrition Journal 10: e-article 15, 2011. (5 refs.)

The coronary endothelial function is recognized to have an important role in the physiology of the diastolic ventricular relaxation, a phase of the heart cycle that influences the electrocardiographic QT interval. Endothelial function is investigated in vivo by flow mediated dilation (FMD) in the brachial artery and has proven to be a strong predictor of both coronary endothelial function and cardiovascular events. It has been reported that coffee acutely induces FMD changes. In particular, the brachial artery FMD seems to decrease after caffeinated coffee (CC) and to increase after decaffeinated coffee (DC) ingestion. Since the cardiovascular effects of coffee are still a debated matter, this study aimed at investigating with a randomized, double-blind crossover design, if the QT interval of adult healthy subjects (19 males and 21 females) changes in the hour following CC or DC ingestion. Both systolic and diastolic blood pressure were higher in the hour following the ingestion of CC; the heart rate significantly increased 30 minutes after CC ingestion. A significant increase of the QT duration was observed one hour after DC ingestion (398.9 +/- 3.8 vs 405.3 +/- 3.7 msec; P < 0.05), not after CC. The QT interval corrected for heart rate did not significantly change following CC or DC ingestion. In conclusion, despite CC and DC previously demonstrated to influence the FMD they do not seem to induce a significant unfavourable acute change of the left ventricular repolarization. Further investigations are required to elucidate the effects of coffee in subjects with cardiovascular diseases.

Campbell RB. A delicate diplomatic situation. (editorial). Journal of Clinical Epidemiology 63(8): 815-817, 2010. (31 refs.)

Chang AM; Walsh KM; Shofer FS; McCusker CM; Litt HI; Hollander JE. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary syndrome. Academic Emergency Medicine 18(1): 1-9, 2011. (44 refs.)

Objectives: Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS). Methods: The authors conducted a cross-sectional study of low- to intermediate-risk patients < 60 years of age who received coronary computerized tomographic angiography (CTA) for evaluation of coronary artery disease (CAD) in the ED. Patients were classified into three groups with respect to CAD: maximal stenosis < 25%, 25% to 49%, and >= 50%. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD. Results: Of 912 enrolled patients, 157 (17%) used cocaine. A total of 231 patients had CAD >= 25%; 111 had CAD >= 50%. In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. 14%; relative risk [RR] = 0.89, 95% confidence interval [CI] = 0.5 to 1.4) or 50% or greater (12% vs. 11%; RR = 1.15, 95% CI = 0.6 to 2.3). In multivariate modeling adjusting for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction (TIMI) score, cocaine use was not associated with the presence of any coronary lesion (adjusted RR = 0.95, 95% CI = 0.69 to 1.31) or coronary lesions 50% or greater (adjusted RR = 0.78, 95% CI = 0.45 to 1.38). There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD. Conclusions: In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.

Christerson S; Stromberg B. Childhood stroke in Sweden I: incidence, symptoms, risk factors and short-term outcome. Acta Paediatrica 99(11): 1641-1649, 2010. (31 refs.)

Aim: To evaluate the incidence, presenting symptoms, diagnostic delay, risk factors and short-term outcome of childhood stroke in a population-based cohort of Swedish children. Methods: We retrospectively reviewed the records of children experiencing their first stroke during a 7-year period in Uppsala-Orebro Health Care Region covering one-fifth of the Swedish population. Arterial ischaemic stroke (AIS), cerebral sinus venous stroke and nontraumatic haemorrhagic stroke (HS) in children aged > 28 days and < 18 years were included. Results: We identified 51 children (23 boys and 28 girls; median age 13). The average annual incidence of stroke was 1.8 per 100,000 children. AIS was found in 51% of the children, HS in 41% and cerebral sinus venous stroke in 8%. One-third of the children had underlying diseases, and one-third had vascular malformations. Six girls used oral contraceptives, three of these were smokers and two had iron deficiency anaemia. Two children died in the acute stage (4%), and 40/49 (82%) had some neurological dysfunction at discharge. Conclusion: The incidence of childhood stroke was 1.8 per 100,000 children and year, and the primary mortality was 4%. Risk factors of importance were oral contraceptives, smoking and anaemia in combinations.

Cottencin O; Karila L; Lambert M; Arveiller C; Benyamina A; Boissonas A et al. Cannabis arteritis: Review of the literature. (review). Journal of Addiction Medicine 4(4): 191-196, 2010. (53 refs.)

Consumption of cannabis in young adults has continued to increase in recent years. Cannabis arteritis was first described in the 1960s, but the number of cases has continued to increase. We reviewed current knowledge of the different types of cannabis arteritis in young adults and found 70 cases of cannabis arteritis in the literature. We discuss physiopathological arguments in favor of cannabis vascular toxicity per se, although we did not find sufficient evidence to identify cannabis arteritis as a specific diagnostic entity. Many factors suggest a link between cannabis consumption and arteritis in young adults, but it is difficult to say whether this type of arteritis is similar to thromboangiitis obliterans. We were unable to demonstrate a formal association between cannabis smoking and the development of thromboangiitis obliterans, because most case reports showed associated tobacco smoking (97%) and the number of years cannabis had been smoked by the participants was mostly unknown. Cannabis consumption would however seems to be an aggravating factor, together with tobacco, in arteritis, which occurs in young adults.

Daganzo S; Nune G. Pot shots: Cannabis arteritis of the digits. (editorial). Journal of Hospital Medicine 5(7): 424-425, 2010. (3 refs.)

A 46-year-old man with a history of heavy marijuana use for 30 years presented to the emergency room with 1 month of progressively worsening distal extremity pain and numbness that had developed into necrosis at the tips of his fingers. The patient did not have other systemic symptoms. Transthoracic echocardiogram was normal. An evaluation for "hypercoagulable" disorders, blood cultures, C-ANCA, cryoglobulins, Hepatitis C serologies, and human immunodeficiency virus (HIV) serologies were all negative. Erythrocyte sedimentation rate was within normal limits. An arteriogram of the hands showed distal subsegmental obliteration of digital arteries, which was consistent with thromboangiitis obliterans (Buerger's Disease). While the patient rarely consumed tobacco, he reported smoking up to 10 marijuana cigarettes daily and a diagnosis of cannabis arteritis was made. The patient was encouraged to discontinue smoking and at follow-up he had marked improvement in symptoms with abstinence from marijuana.

Debar S; Kumarapeli P; Kaski JC; de Lusignan S. Addressing modifiable risk factors for coronary heart disease in primary care: An evidence-base lost in translation. Family Practice 27(4): 370-378, 2010. (28 refs.)

Objective. To observe how the evidence base for assessing and managing cardiovascular risk is implemented in practice. Method. We compared the different risk calculators promoted for calculating cardiovascular risk in primary care using four test cases. We looked to see how these calculators were implemented in primary care EPR systems. We explored through a workshop which risk factors GPs thought were important and felt motivated to address as part of clinical care. Results. The risk calculators reviewed use different sets of risk factors and the levels of risk calculated for the same test patient profiles vary by up to 100%. The risk factor calculators embedded within UK computer systems all include the Framingham equation though there is variation in interface, default values and patient groups included. GPs showed consensus around the importance of managing smoking, blood pressure, obesity (body mass index), diabetes and cholesterol but also stressed the importance of providing personalized care and exercising professional judgement. Conclusions. There appears to be an evidence-base lost in translation. Different guidelines calculate risk differently, and even when the same guideline is used, variation in implementation leads to further variation. Education and development of improved risk calculators should enable the most appropriate calculator to be used for an individual patient; accreditation of implementation could be achieved through the use of a standard set of test cases.

Demarie D; Marletta G; Imazio M; Cappa C; Ferro S; Compostino R et al. Cardiovascular-associated disease in an addicted population: An observation study. Journal of Cardiovascular Medicine 12(1): 51-54, 2011. (16 refs.)

Background: Illicit drugs such as cocaine, and methadone can induce acquired long QT syndrome. Objective: The aim of this study was to evaluate the prevalence of cardiovascular disease and to assess the risk of torsades de pointes in substance abuse patients either with methadone or buprenorphine maintenance therapy, or without any specific therapy for opiate addiction. Methods: From November 2008 to December 2009, 190 patients (153 men, mean age 38.2 years, 22-56 years) with a substance use disorder according to DSM IV TR criteria were included in the study. All patients underwent blood tests, serial electrocardiogram (ECG) and, when necessary, additional testing, including echocardiogram, exercise test and Holter monitoring. Age and sex-matched healthy controls were also evaluated and compared with the cases. Results: One hundred and twenty-five patients (65.7%) had associated diseases. The prevalence of coronary artery disease and hypertension was, respectively, 2.1 and 5.2% in the addicted population. The percentage of abnormal ECGs was 34.2% in the addicted population and 4.7% in the nonaddicted population (P<0.001). Twenty-five addicted patients had a QT interval prolongation (10 patients >= 480 ms). There were no sudden deaths or major cardiac events during the observation period. Conclusions: Our results indicate that the QT interval prolongation is not a negative prognostic marker in the addicted population, even with associated diseases. ECG should be performed when other drugs potentially prolonging QT interval are associated. Substance abuse patients should be followed by multidisciplinary teams, and blood tests and ECGs should be performed regularly.

Dove MS; Dockery DW; Mittleman MA; Schwartz J; Sullivan EM; Keithly L et al. The impact of Massachusetts' smoke-free workplace laws on acute myocardial infarction deaths. American Journal of Public Health 100(11): 2206-2212, 2010. (33 refs.)

Objectives. We examined the rate of acute myocardial infarction (AMI) deaths in Massachusetts before and after the implementation of a comprehensive smoke-free workplace law in July 2004. Methods. We used Poisson regression models to examine the impact of the state law in cities and towns with and without previous local smoking bans and the effect of the local laws for the period of 1999 through 2006. Results. The AMI mortality rate decreased by 7.4% (95% confidence interval [CI]=3.3%, 11.4%) after implementation of the state law. The state ban had an impact in cities and towns with no prior local smoking ban (9.2% decrease; P<.001) but not cities and towns with a prior local smoking ban. However, there was a nonsignificant 4.9% (95% CI=-5.0%, 13.9%) decrease associated with the local smoking ban that preceded the effect of the state ban. The effect of the state ban was modest (-1.6%) in the first 12 months after implementation but much larger after the first 12 months (-18.6%; P<.001). Conclusions. Comprehensive statewide smoke-free workplace laws in Massachusetts were associated with an estimated 270 fewer AMI deaths per year. These results add to the evidence suggesting that smoke-free air laws are associated with lower rates of AMI.

Fareed A; Vayalapalli S; Byrd-Sellers J; Casarella J; Drexler K; Amar R et al. Onsite QTc interval screening for patients in methadone maintenance treatment. Journal of Addictive Diseases 29(1): 15-22, 2010. (39 refs.)

To improve the electrocardiogram screening process and early detection of patients at high risk for cardiac arrhythmias, the authors created a model in their clinic where they provided an onsite electrocardiogram screening that might be feasible and practical. The authors then performed a retrospective chart review to access the efficacy and feasibility of their new onsite procedure in identifying methadone maintained patients at high risk for cardiac arrhythmias. Records from all patients who are currently or had previously been maintained on methadone in the methadone maintenance program at the Atlanta VA Medical Center between 2002 and 2009 were evaluated. Of the 140 patients treated at the clinic between 2002 and 2009, 85 were excluded from the study because they had been treated as guests (had been in treatment in other clinics but received methadone dosing temporarily from our clinic), were treated in the clinic for less than 6 months, or dropped out of treatment. Thus, 55 patient charts were selected for review. Most patients (95%) received baseline and annual electrocardiogram screening. The average baseline QTc was (417 +/- 30) and most recent QTc (442 +/- 25). This QTc prolongation from baseline showed statistical significance (P < .0001). Sixty-seven percent of patients had statistically significant QTc prolongation from baseline but was less than 450 ms (mean: 428 +/- 16, P = .008). Twenty-seven percent of patients had statistically significant QTc prolongation from baseline of more 450 ms but was less than 500 ms (mean: 460 +/- 8, P <. 0001). Six percent of patients had statistically significant QTc prolongation from baseline of more 500 ms (mean: 503 +/- 1.15, P = .027). Recent cocaine use was the only individual variable that showed statistically significant correlation with QTc prolongation (F = 6.98, P = .01). The authors demonstrated in this study that providing an onsite electrocardiogram screening with a focus on patient education and limiting the referral to specialty care for patients at high risk for cardiac arrhythmias could be practical and feasible.

Gaemperli O; Liga R; Bhamra-Ariza P; Rimoldi O. Nicotine addiction and coronary artery disease: Impact of cessation interventions. (review). Current Pharmaceutical Design 16(23): 2586-2597, 2010. (152 refs.)

Cigarette smoking is the leading preventable cause of death worldwide, and a considerable proportion of smoking-related fatalities are attributable to coronary artery disease (CAD). The detrimental effects of smoking span all stages in the development of CAD ranging from the early functional alterations in the endothelium and the microcirculation to the late clinicopathological manifestations of atherosclerotic plaques. Smoking results in the generation of free radicals and increased oxidative stress which plays a central role in the pathogenetic mechanisms leading to atherosclerotic disease. It causes reduced nitric oxide bioavailability and lipid peroxidation which are crucial initial steps of plaque formation. Furthermore, smoking enhances leukocyte and platelet activation and promotes local and systemic inflammation, which contribute to plaque progression and maturation. Finally, alterations in fibrinolytic and prothrombotic factors create a pro-thrombogenic environment which harbours the risk of plaque rupture and thrombosis. In smokers, the cessation of smoking is the most important intervention for cardiovascular risk reduction. Total mortality can be reduced by 36% which is comparable to established modern secondary preventive therapies. Nonetheless, non-aided cessation attempts are notoriously poor with a success rate of less than 10%. Patient counselling and pharmacological therapies are important aides for smoking cessation and can improve success rates by two to threefold. However, there is still need for improved strategies of smoking cessation to reduce the high socioeconomic impact of smoking.

Gans JMD; Uiterwaal CSPM; van der Schouw YT; Boer JMA; Grobbee DE; Verschuren WMM et al. Tea and coffee consumption and cardiovascular morbidity and mortality. Arteriosclerosis, Thrombosis and Vascular Biology 30(8): 1665-U333, 2010. (27 refs.)

Objective-To examine the associations of coffee and tea consumption with risk of morbidity and mortality of stroke and coronary heart disease (CHD) and with all-cause mortality. Methods and Results-Coffee and tea consumption were assessed with a validated food-frequency questionnaire, and 37 514 participants were observed for 13 years for the occurrence of cardiovascular morbidity and mortality. A U-shaped association between coffee and CHD was found, with the lowest hazard ratio (HR [95% CI]) for 2.1 to 3.0 cups per day (0.79 [0.65 to 0.96]; P-trend=0.01). Tea was inversely associated with CHD, with the lowest HR (95% CI) for more than 6.0 cups per day (0.64 [0.46 to 0.90]; P-trend=0.02). No associations between tea or coffee and stroke were found (P-trend=0.63 and P-trend=0.32, respectively). Although not significant, coffee slightly reduced the risk for CHD mortality (HR, 0.64; 95% CI, 0.37 to 1.11; P-trend=0.12) for 3.1 to 6.0 cups per day. A U-shaped association between tea and CHD mortality was observed, with an HR of 0.55 (95% CI, 0.31 to 0.97; P-trend=0.03) for 3.1 to 6.0 cups per day. Neither coffee nor tea was associated with stroke (P-trend=0.22 and P-trend=0.74, respectively) and all-cause mortality (P-trend=0.33 and P-trend=0.43, respectively). Conclusion-High tea consumption is associated with a reduced risk of CHD mortality. Our results suggest a slight risk reduction for CHD mortality with moderate coffee consumption and strengthen the evidence on the lower risk of CHD with coffee and tea consumption.

Gastaldelli A; Folli F; Maffei S. Impact of tobacco smoking on lipid metabolism, body weight and cardiometabolic risk. (review). Current Pharmaceutical Design 16(23): 2526-2530, 2010. (70 refs.)

Tobacco smoking is the most important preventable cause of cardiovascular disease. In this paper we review current epidemiological and pathophysiological evidence linking smoking with cardiovascular and metabolic diseases. Among the effects of smoking there is the alteration of lipid metabolism through the increase in lipolysis, insulin resistance and tissue lipotoxicity. Smoking is both prothrombotic and atherogenic. As an effect, the risk of acute myocardial infarction, sudden cardiac death, stroke, aortic aneurysm and peripheral vascular disease is increased. Even very low doses of exposure increase the risk of cardiovascular disease (CVD) and metabolic alterations. On the other hand, smoking cessation restores, at least in part, lipid metabolism and the benefits can be observed already after a short period of abstinence from smoking, although it occurs several years before the risks approach those of the never-smoker.

Getahun W; Gedif T; Tesfaye F. Regular Khat (Catha edulis) chewing is associated with elevated diastolic blood pressure among adults in Butajira, Ethiopia: A comparative study. BMC Public Health 10: article 390, 2010. (33 refs.)

Background: Fresh leaves and buds of the Khat plant (Catha edulis) contain Cathinone, an amphetamine like alkaloid responsible for its pharmacological action. Chewing of Khat has been associated with a transient rise in blood pressure and heart rate in experimental studies. Few studies examined the effect of regular or frequent Khat chewing on blood pressure at the population level. This study was conducted to examine the association of regular Khat chewing with blood pressure among adults. Methods: We compared systolic and diastolic blood pressure of adults 35-65 years of age who reported regular chewing of Khat during the preceding five years to those who never chewed Khat during the same period. Study participants were recruited from purposively selected urban and rural villages of Butajira District in Ethiopia. The comparative groups, chewers (334) and non-chewers (330), were identified from among the general population through a house-to-house visit using a screening questionnaire. They were frequency-matched for sex and age within a five-year range. Data were collected through structured interviews and physical measurements including blood pressure, weight and height. Results: The prevalence of hypertension was significantly higher among Khat chewers (13.4%) than non-chewers (10.7%), odds ratio (OR) = 1.66 (95% confidence interval (CI) 1.05, 3.13). A considerably high proportion of chewers (29.9%) than non-chewers (20.6%) had sub-optimal diastolic blood pressure (> 80 mmHg). The mean (sd) diastolic blood pressure was significantly higher among Khat chewers [75.0 (11.6)] than non-chewers [72.9 (11.7)], P < 0.05. Similarly, Khat chewers had significantly higher mean (sd) heart rate [76.3 (11.5)] than non-chewers [73.9 (12.6)], P < 0.05. There was no significant difference in mean systolic blood pressure between the two groups. Conclusion: Regular chewing of Khat is associated with elevated mean diastolic blood pressure, which is consistent with the peripheral vasoconstrictor effect of Cathinone. Regular Khat chewing may have sustained effects on the cardiovascular system that can contribute to elevated blood pressure at the population level.

Gianicolo EAL; Cresci M; Ait-Ali L; Foffa I; Andreassi MG. Smoking and congenital heart disease: The epidemiological and biological link. (review). Current Pharmaceutical Design 16(23): 2572-2577, 2010, 2010. (52 refs.)

Cigarette smoking is a powerful human germ cell mutagen and teratogen. Congenital heart defects (CHD) are the most prevalent of all birth defects and leading cause of death in the first year of life. The purpose of this article is to review the epidemiology of the impact of cigarette smoking on CHD risk as well as to discuss the potential biological mechanisms of smoking-mediated abnormal cardiac development. Although epidemiological studies of association between parental smoking and CHD are limited, biological evidence supports the concept that cigarette smoking may substantially contribute to the aetiology of CHD through induction of either male and female germ-cell mutation or interference with epigenetic pathways. Further research is needed to better define the relationship between parental smoking and the risk of heart defects as well as to assess parental-fetal gene-smoking interactions.

Gjeilo KH; Stenseth R; Klepstad P; Lydersen S; Wahba A. Patterns of smoking behaviour in patients following cardiac surgery. A prospective study. Scandinavian Cardiovascular Journal 44(5): 295-300, 2010. (24 refs.)

Objectives. To describe patterns of smoking behaviour in patients undergoing cardiac surgery. Design. A prospective population-based study of patients undergoing cardiac surgery between September 2004 and September 2005. Smoking behaviour and socio-demographic variables were obtained by questionnaires at baseline, six and 12 months after surgery. Results. At baseline 534 patients (median age 69 years, 23% females) were included, 89% responded after six and 12 months. At baseline 14% (n=74) were current smokers, 59% (n=316) were former smokers and 27% (n=143) had never smoked. At six months 8% were current smokers (n=36) while 9% (n=40) were current smokers at 12 months. A total of nine smokers had relapsed at 12 months. Conclusion. About half of the current smokers gave up smoking after cardiac surgery. Changes in smoking behaviour were most likely to occur during the first six months. This supports that smoking cessation interventions should continue after discharge. Cardiac surgery can serve as a teachable moment; an opportunity to encourage patients to give up smoking and prevent relapses among those who stopped smoking before surgery.

Hamidovic A; Childs E; Conrad M; King A; de Wit H. Stress-induced changes in mood and cortisol release predict mood effects of amphetamine. Drug and Alcohol Dependence 109(1-3): 175-180, 2010. (47 refs.)

Background: Stress is thought to contribute to both initiation and relapse to drug abuse. However, the mechanisms by which stress influences drug use are unclear. Interestingly, responses to acute administration of stimulant drugs resemble certain neuronal and hormonal responses to acute stress, and there is accumulating evidence that individual variation in the positive reinforcing or euphorigenic effects of a drug is related to individual differences in responsivity to acute stress. Methods: In this study we evaluated relationships between physiological and subjective responses to a stressful task and to an oral dose of d-amphetamine in healthy adult volunteers (N=34). Individuals participated in four experimental sessions; two behavioral sessions involving a stressful task (i.e., public speech) or a non-stressful control task, and two drug sessions involving oral administration of d-amphetamine (20 mg) or a placebo. The dependent measures included salivary cortisol, heart rate, mean arterial pressure, and subjective ratings of mood. Results: As expected, both stress and d-amphetamine increased cortisol, heart rate and blood pressure. Stress increased negative mood, whereas d-amphetamine induced prototypic stimulant effects and increased ratings of drug liking. Analyses revealed that increased negative mood states after stress were correlated with positive mood after amphetamine. In addition, increased cortisol after stress was correlated with positive mood responses to amphetamine. Finally, there were modest positive correlations between cortisol and heart rate increases after stress and mean arterial pressure after amphetamine. Conclusions: These results support and extend previous observations that responses to acute stress are correlated with certain subjective, hormonal and cardiovascular effects of a stimulant drug.

Hennrikus D; Joseph AM; Lando HA; Duval S; Ukestad L; Kodl M; Hirsch AT. Effectiveness of a smoking cessation program for peripheral artery disease patients: A randomized controlled trial. Journal of The American College of Cardiology 56(25): 2105-2112, 2010. (29 refs.)

Objectives This study tested the effectiveness of a smoking cessation program designed for patients with peripheral artery disease (PAD). Background Tobacco use is the leading risk factor for PAD incidence and progression and for ischemic events. Tobacco cessation reduces PAD-related morbidity and mortality, yet few prospective clinical trials have evaluated smoking cessation interventions in PAD patients. Methods: We recruited outpatients with lower extremity PAD identified from medical records as cigarette smokers. Participants were randomly assigned to an intensive tailored PAD-specific counseling intervention or a minimal intervention. Participants completed surveys at baseline and at 3- and 6-month follow-up. Reported 7-day point prevalent smoking abstinence was confirmed by cotinine or carbon monoxide assessment. Results: In all, 687 outpatients were identified as probable smokers with lower extremity PAD; 232 met study eligibility requirements; and 124 (53% of eligible) enrolled. Participants were receptive to counselor contact: the median number of sessions was 8.5 (range 0 to 18). Participants randomly assigned to the intensive intervention group were significantly more likely to be confirmed abstinent at 6-month follow-up: 21.3% versus 6.8% in the minimal intervention group (chi-square = 5.21, p = 0.023). Conclusions Many long-term smokers with PAD are willing to initiate a serious quit attempt and to engage in an intensive smoking cessation program. Intensive intervention for tobacco dependence is a more effective smoking cessation intervention than minimal care. Studies should be conducted to examine the long-term effectiveness of intensive smoking cessation programs in this population to examine the effect of this intervention on clinical outcomes related to PAD.

Hiestand BC; Smith SW. Cocaine chest pain: Between a (crack) rock and a hard place ... (editorial). Academic Emergency Medicine 18(1): 68-71, 2011. (25 refs.)

Hirata K; Yamano Y; Suzuki H; Miyagawa S; Nakadate T. Passive smoking is associated with lower serum HDL-C levels in school children. Pediatrics International 52(2): 252-256, 2010. (16 refs.)

Background: In recent years, a number of studies have reported that exposure to environmental tobacco smoke (ETS) reduces high-density lipoprotein cholesterol (HDL-C) levels in children, as well as in adults. Further, a number of countries have indicated that passive smoking increases the risk of early arteriosclerosis onset. Here, to evaluate the effects of ETS exposure, we conducted a cross-sectional epidemiological study on primary school children in Japan using answers from a questionnaire survey, as well as urine cotinine and lipid metabolism-related variable measurements. Methods: A total of 121 sixth-grade primary school children participated in this study by completing a questionnaire about their food intake, lifestyle and family smoking habits. Early in the morning, we also measured height, weight, blood pressure, serum levels of total cholesterol, triglyceride, HDL-C, and blood sugar, as well as urine levels of cotinine and creatinine under unfed conditions. Results: From the questionnaire, 40 and 81 children reported being exposed and not exposed to ETS, respectively. Serum HDL-C levels, which were adjusted for the degree of corpulence and exercise habits, were significantly lower in the passive smoker group than the non-passive-smoker group (65.3 and 72.1 mg/dL, respectively; P = 0.012). In addition, proportional differences in serum HDL-C levels were also observed based on the amount of cigarettes smoked at home by family members of the child. Conclusions: Results: suggest that ETS exposure at home is associated in a dose-related manner with lower serum HDL-C levels in primary school children. In addition, our results suggest that smoking in the presence of children who are not usually exposed to ETS increases the risk of arteriosclerosis. Given these findings, we strongly recommend the establishment of anti-passive-smoking measures.

Hoogwegt MT; Hoeks SE; Pedersen SS; op Reimer WJMS; van Gestel YRBM; Verhagen HJM et al. Smoking cessation has no influence on quality of life in patients with peripheral arterial disease 5 years post-vascular surgery. European Journal of Vascular and Endovascular Surgery 40(3): 355-362, 2010. (35 refs.)

Objectives: Smoking is an important modifiable risk factor in patients with peripheral arterial disease (PAD). We investigated differences in quality of life (QoL) between patients who quitted smoking during follow-up and persistent smokers. Design: Cohort study. Methods: Data of 711 consecutively enrolled patients undergoing vascular surgery were collected in 11 hospitals in the Netherlands. Smoking status was obtained at baseline and at 3-year follow-up. A 5-year follow-up to measure QoL was performed with the EuroQol-5D (EQ-5D) and Peripheral Arterial Questionnaire (PAQ). Results: After adjusting for clinical risk factors, patients, who quit smoking within 3 years after vascular surgery, did not report an impaired QoL (EQ-5D: odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.28-1.43; PAQ: OR = 0.76, 95% CI = 0.35-1.65; visual analogue scale (VAS): OR = 0.88, 95% CI = 0.42-1.84) compared with patients, who continued smoking. Current smokers were significantly more likely to have an impaired QoL (EQ-5D: OR = 1.86, 95% CI = 1.09-3.17; PAQ: OR = 1.63, 95% CI = 1.00-2.65), although no differences in VAS scores were found (OR = 1.17, 95% CI = 0.72-1.90). Conclusions: There was no effect of smoking cessation on QoL in PAD patients undergoing vascular surgery. Nevertheless, given the link between smoking, complications and mortality in this patient group, smoking cessation should be a primary target in secondary prevention.

Hysek CM; Vollenweider FX; Liechti ME. Effects of a beta-blocker on the cardiovascular response to MDMA (Ecstasy). Emergency Medicine Journal 27(8): 586-589, 2010. (26 refs.)

Background: MDMA (3,4-methylenedioxymethamphetamine, 'Ecstasy') produces tachycardia and hypertension and is rarely associated with cardiovascular and cerebrovascular complications. In clinical practice, beta-blockers are often withheld in patients with stimulant intoxication because they may increase hypertension and coronary artery vasospasm due to loss of beta(2)-mediated vasodilation and unopposed alpha-receptor activation. However, it is unknown whether beta-blockers affect the cardiovascular response to MDMA. Methods: The effects of the non-selective beta-blocker pindolol (20 mg) on the cardiovascular effects of MDMA (1.6 mg/kg) were investigated in a double-blind placebo-controlled crossover study in 16 healthy subjects. Results: Pindolol prevented MDMA-induced increases in heart rate. Peak values (mean+/-SD) for heart rate were 84+/-13 beats/min after MDMA vs 69+/-7 beats/min after pindolol-MDMA. In contrast, pindolol pretreatment had no effect on increases in mean arterial blood pressure (MAP) after MDMA. Peak MAP values were 115+/-11 mm Hg after MDMA vs 114+/-11 mm Hg after pindolol-MDMA. Pindolol did not change adverse effects of MDMA. Conclusion: The results of this study indicate that beta-blockers may prevent increases in heart rate but not hypertensive and adverse effects of MDMA.

Ijsselmuiden A; Verheye S. Cocaine-induced coronary artery dissection. (editorial). JACC. Cardiovascular Interventions 2(10): 1031-1031, 2009. (0 refs.)

Johansson S; Wilhelmsen L; Welin C; Eriksson H; Welin L; Rosengren A. Obesity, smoking and secular trends in cardiovascular risk factors in middle-aged women: data from population studies in Goteborg from 1980 to 2003. Journal of Internal Medicine 268(6): 594-603, 2010. (49 refs.)

Background. To study the trends in cardiovascular risk factors in middle-aged city-dwelling Swedish women from 1980 to 2003. Methods. Using cross-sectional population-based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50-year-old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress. Results. Over almost 25 years, middle-aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m-2. The proportion of participants classified as obese (>= 30 kg m-2) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status - no smoking, normotension and serum cholesterol < 5 mmol l-1- was present in less than one in six women in 2003, and similar across BMI categories. Conclusion. The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight.

Karabulut A; Cakmak M. ST segment elevation myocardial infarction due to slow coronary flow occurring after cannabis consumption. Kardiologia Polska 68(11): 1266-1268, 2010. (13 refs.)

Slow coronary flow (SCE) is an angiographic finding defined as the slow movement of contrast throughout the coronary lumen in the absence of epicardial coronary stenosis. It has been reported that SCF can on rare occasions cause ST elevated myocardial infarction (MI). Recent studies have shown that cannabis consumption can increase the risk of coronary heart disease and can trigger acute coronary syndromes, especially in young individuals without common risk factors. Here, we present a case of inferior MI in a patient who had consumed cannabis regularly over a long period and whose coronary angiography revealed SCF.

Karumanchi SA; Levine RJ. How does smoking reduce the risk of preeclampsia? (editorial). Hypertension 55(5): 1100-1101, 2010. (14 refs.)

Khawaja O; Al-Mallah M. The impact of public smoking ban on the incidence of myocardial infarction hospitalizations. (review). Reviews In Cardiovascular Medicine 11(3): E121-E129, 2010. (44 refs.)

Smoking is a well-established risk factor for cardiovascular disease (CVD) and acute myocardial infarction (AMI) Exposure to tobacco smoke is associated with an estimated 35,000 cardiovascular deaths per year in nonsmokers. In addition, the risk of CVD decreases with the cessation of exposure to smoking. Association of smoking with CVD has been well known for years, however, association of secondhand smoke with CVD has been a topic of great interest, especially for the past 2 decades Multiple studies and articles have evaluated the impact of smoking ban on the incidence of AMI-related hospitalizations In this article, we discuss the effect of smoking ban on the economy and on human health in general, as well as its potential effects on the prevalence of smoking.

Kuciene R; Dulskiene V. Parental cigarette smoking and the risk of congenital heart septal defects. Medicina-Lithuania 46(9): 635-641, 2010. (28 refs.)

The objective of this study was to determine the association between parental cigarette smoking and the risk of congenital heart septal defects in Kaunas infant population in 1995-2005. Material and methods. An epidemiological case-control study was conducted. The study comprised 261 newborns with congenital heart septal defects (cases) and 1122 randomly selected newborns without any defects (controls), born in Kaunas city during 1995-2005. Information on potential risk factors of newborns' health was collected through an interview with parents using standardized questionnaires. Multivariate logistic regression analysis was used to assess the association between parental smoking and septal defects while controlling for possible confounders. Results. According to the validated registry, 371 newborns with congenital heart malformations were born in Kaunas city during 1995-2005; 70.3% of cases had ventricular and/or atrial septal defects. After adjustment for possible confounding factors maternal education, social status, marital status a statistically significant relationship was observed between parental smoking and congenital heart septal defects. Parental, maternal, and paternal smoking was significantly associated with a 2.27-fold (adjusted OR=2.27; 95% CI, 1.49-3.46), 2.2-fold (adjusted OR=2.20; 95% CI, 1.01-4.79), and 1.45-fold (adjusted OR=1.45; 95% CI, 1.03-2.03) increased risk of defects if compared with nonsmoking parents. Conclusions. According to the results of our study, parental smoking was significantly associated with an increased risk of congenital heart septal defects in infants.

Ladapo JA; Jaffer FA; Weinstein MC; Froelicher ES. Projected cost-effectiveness of smoking cessation interventions in patients hospitalized with myocardial infarction. Archives of Internal Medicine 171(1): 39-45, 2011. (47 refs.)

Background: As many as 70% of smokers with acute myocardial infarction (AMI) continue to smoke after hospital discharge despite high rates of inpatient smoking cessation counseling. Supportive contact after discharge improves quit rates but is rarely used. Methods: Using data from a meta-analysis of randomized trials of smoking cessation interventions and other published sources, we developed a Monte Carlo model to project health and economic outcomes for a hypothetical US cohort of 327 600 smokers hospitalized with AMI. We compared routine care, consisting of advice to quit smoking, with counseling with supportive follow-up, consisting of routine care and follow-up telephone calls from a nurse after discharge. Primary outcomes were number of smokers, AMIs, and deaths averted; health care and productivity costs; cost per quitter; and cost per quality-adjusted life-year. Results: Implementation of smoking cessation counseling with follow-up contact for the 2010 cohort of hospitalized smokers would create 50 230 new quitters, cost $27.3 million in nurse wages and materials, and prevent 1380 nonfatal AMIs and 7860 deaths. During a 10-year period, it would save $22.1 million in reduced hospitalizations but increase health care costs by $166.4 million, primarily through increased longevity. Productivity costs from premature death would fall by $1.99 billion and nonmedical expenditures would increase by $928 million, for a net positive value to society of $894 million. The program would cost $540 per quitter considering only intervention costs. Cost-effectiveness would be $5050 per quality-adjusted life-year. Results were sensitive to the utility and incidence of nonfatal AMI and the potential effect of pharmacotherapies. Conclusion: Smoking cessation counseling with supportive contact after discharge is potentially cost-effective and may reduce the incidence of smoking and its associated adverse health events and social costs.

Land T; Rigotti NA; Levy DE; Paskowsky M; Warner D; Kwass JA et al. A longitudinal study of Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in hospitalizations for cardiovascular disease. PLoS Medicine 7(12): e1000375, 2010. (25 refs.)

Background: Insurance coverage of tobacco cessation medications increases their use and reduces smoking prevalence in a population. However, uncertainty about the impact of this coverage on health care utilization and costs is a barrier to the broader adoption of this policy, especially by publicly funded state Medicaid insurance programs. Whether a publicly funded tobacco cessation benefit leads to decreased medical claims for tobacco-related diseases has not been studied. We examined the experience of Massachusetts, whose Medicaid program adopted comprehensive coverage of tobacco cessation medications in July 2006. Over 75,000 Medicaid subscribers used the benefit in the first 2.5 years. On the basis of earlier secondary survey work, it was estimated that smoking prevalence declined among subscribers by 10% during this period. Methods and Findings: Using claims data, we compared the probability of hospitalization prior to use of the tobacco cessation pharmacotherapy benefit with the probability of hospitalization after benefit use among Massachusetts Medicaid beneficiaries, adjusting for demographics, comorbidities, seasonality, influenza cases, and the implementation of the statewide smoke-free air law using generalized estimating equations. Statistically significant annualized declines of 46% (95% confidence interval 2%-70%) and 49% (95% confidence interval 6%-72%) were observed in hospital admissions for acute myocardial infarction and other acute coronary heart disease diagnoses, respectively. There were no significant decreases in hospitalizations rates for respiratory diagnoses or seven other diagnostic groups evaluated. Conclusions: Among Massachusetts Medicaid subscribers, use of a comprehensive tobacco cessation pharmacotherapy benefit was associated with a significant decrease in claims for hospitalizations for acute myocardial infarction and acute coronary heart disease, but no significant change in hospital claims for other diagnoses. For low-income smokers, removing the barriers to the use of smoking cessation pharmacotherapy has the potential to decrease short-term utilization of hospital services.

Lardi E; Ott C; Schulzki T; Kuhn M; Bonetti PO; Reinhart WH. Acute effects of short-term exposure to second-hand smoke on induced platelet aggregation. Clinical Hemorheology and Microcirculation 45(2-4): 359-364, 2010. (20 refs.)

Passive smoking may increase cardiovascular events by yet insufficiently understood mechanisms. We, therefore, tested the hypothesis that passive smoking could affect platelet aggregation. Fourteen healthy non-smoking males were exposed to second-hand smoke during 60 min in a room with smokers, who maintained the CO-concentration between 4.5-7.0 ppm throughout that period. Citrated blood was drawn before and immediately after smoke exposure (which took place between 6 and 7 p. m.). The last 7 individuals had blood taken also at 9.00 a. m. before and the day after smoke exposure. Platelet aggregation was measured (a) in flowing whole blood using the platelet function analyser PFA-100 (R), which determines the closure time (CT) of a collagen coated membrane pore by shear-induced platelet aggregation, and (b) with a Chrono-log 700 Aggregometer, assessing platelet aggregation either by the change of impedance in diluted whole blood or light transmission in platelet-rich plasma. After short term second-hand smoke exposure we did not observe an increase in platelet aggregation with any of the instruments. We conclude that acute exposure to second-hand smoke is unlikely to increase platelet aggregability. Other mechanisms must be involved in the increased risk of cardiovascular events associated with passive smoking.

Leon DA; Shkolnikov VM; McKee M; Kiryanov N; Andreev E. Alcohol increases circulatory disease mortality in Russia: Acute and chronic effects or misattribution of cause? International Journal of Epidemiology 39(5): 1279-1290, 2010. (34 refs.)

Methods: Analysis of routine mortality data and of a case-control study of mortality among working-age (25-54 years) men occurring in the Russian city of Izhevsk, west of the Ural mountains, 2003-05. Interviews were carried out with proxy informants for both the dead cases (N = 1750) and the controls (N = 1750) selected at random from a population register. Mortality was analysed according to indicators of alcohol problems. Results: Hazardous drinking was associated with an increased risk of death from circulatory diseases as a whole [odds ratio (OR) = 4.14, 95% confidence interval (CI) 3.23, 5.31] adjusted for age, smoking and education. The association with alcoholic cardiomyopathy was particularly strong (OR = 15.7, 95% CI 9.5, 25.9). Although there was no association with deaths from myocardial infarction (MI; OR = 1.17, 95% CI 0.59, 2.32), there was a strong association with the aggregate of all other ischaemic heart disease (IHD; OR = 4.04, 95% CI 2.79, 5.84). Stronger associations for each of these causes (other than MI) were seen with whether or not the man had drunk very heavily in the previous week. However, associations also remained when analyses were restricted to subjects with no evidence of recent heavy drinking, suggesting that misclassification of acute alcohol poisonings is unlikely to explain these overall associations. Conclusion Taken as a whole, the available evidence suggests that the positive association of alcohol with increased cardiovascular disease mortality may be best explained as being the result of a combination of chronic and acute alcohol consumption resulting in alcohol-related cardiac disorders, especially cardiomyopathy, rather than being due to misclassification of acute alcohol poisoning. Further work is required to understand the mechanisms underlying the link between heavy alcohol consumption and deaths classified as being due to IHD (other than MI).

Leung DYP; Lam TH; Chan SSC. Three versions of Perceived Stress Scale: Validation in a sample of Chinese cardiac patients who smoke. BMC Public Health 10: 513, 2010. (46 refs.)

Background: Smoking causes heart disease, the major cause of death in China and Hong Kong. Stress is one major trigger of smoking and relapse, and understanding stress among smoking cardiac patients can therefore help in designing effective interventions to motivate them to quit. The objective of this study was to examine the psychometric properties of the Perceived Stress Scale (PSS), and to compare the appropriateness of the three versions of the scale (PSS-14, PSS-10, and PSS-4) among Chinese cardiac patients who were also smokers. Methods: From March 2002 to December 2004, 1860 cardiac patients who smoked were recruited at the cardiac outpatient clinics of ten acute hospitals in Hong Kong, and 1800 questionnaires were analysed. Participants completed a questionnaire including the PSS, nicotine dependence and certain demographic variables. The psychometric properties of the PSS were investigated: construct validity using confirmatory factor analysis, reliability using Cronbach's alpha and concurrent validity by examining the relationship with smoking-and health-related variables. Results: For all the three versions of the PSS, confirmatory factor analyses corroborated the 2-factor structure of the scale, with the positive and negative factors correlating significantly and negatively to a moderate extent (r < -0.5), and high Cronbach's alpha values for the two subscales (alpha > 0.5). All the correlations of the two subscales and the smoking-and health-related variables were statistically significant and in the expected directions although of small magnitudes, except daily cigarette consumption. Conclusions: The findings confirmed the satisfactory psychometric properties of all three Chinese versions of PSS. We recommend the use of PSS-10 for research which focuses on the two components of perceived stress, as it shows a higher reliability; and the use of PSS-4 if such partition is not essential and space for multiple measures is limited.

Lindstrom D. Comments regarding 'Measuring effects of smoking and smoking cessation in patients with vascular disease'. (editorial). European Journal of Vascular and Endovascular Surgery 40(3): 363-364, 2010. (5 refs.)

Lippi G; Plebani M; Cervellin G. Cocaine In acute myocardial infarction. (review). Advances In Clinical Chemistry 51: 53-70, 2010. (57 refs.)

Cocaine, a crystalline tropane alkaloid which is obtained from the leaves of the coca plant, acts a powerfully addictive stimulant that directly targets the central nervous system. The effects of the drug appear almost immediately after a single dose (intravenous, intranasal, or inhaled), and disappear within a few minutes or hours. Although the free commercialization of the drug is illicit and severely penalized in virtually all countries, its use remains widespread in many social, cultural, and personal settings. There is a variety of well-recognized side effects of cocaine abuse, which involve virtually every organ system. There is also emerging evidence, however, that cocaine abuse might trigger a variety of cardiac disorders, ranging from arrhythmias to acute myocardial infarction (AMI), heart failure and even sudden cardiac death, especially in relatively young male patients (e.g., those in the mid-1930s), in those who concomitantly use tobacco and alcohol, in those having experienced a trauma or a car accident and lack traditional risk factors for atherosclerosis. Since the use of cocaine may influence the treatment strategies of patients being evaluated for possible acute coronary syndrome (ACS) as well as the prognosis of an AMI, it might be advisable to introduce cocaine screening in patients admitted with chest pain at the emergence department, especially in high-risk patients (i.e., young males with concurrent use of tobacco or alcohol, suffering from a recent accident and with no traditional atherosclerotic risk factors.), or in those who are unresponsive and unreliable. This strategy might be helpful to adopt the best therapeutic approach for reducing the risks associated with cardiovascular disease in these patients, and also to deter relapse.

Logroscino G; Kurth T. Ischemic stroke: Coffee may pull the trigger. (editorial). Neurology 75(18): 1576-1577, 2010. (13 refs.)

In this issue of Neurology, Mostofsky and colleagues 5 challenge the idea of coffee being safe. They test the hypothesis that coffee intake is associated with a transient increase in risk of ischemic stroke. In a multicenter case-crossover study, they studied 390 subjects after an acute ischemic stroke event. Each subject's coffee consumption in the hour before stroke symptoms was compared with their usual consumption over the prior year. Coffee consumption was associated with a 2-fold increase in risk of ischemic stroke in the subsequent hour when compared to the risk during periods without coffee consumption. The increased risk returned to baseline within a 2-hour window, strengthening the plausibility of a causal relationship. This study provides new information that may be useful in stroke prevention and is concordant with what we know of the physiologic effects of coffee. Even if coffee contains other substances that may be responsible for the observed effect, caffeine is the most likely candidate for pulling the trigger. The peak plasma concentration of caffeine is usually less than 2 hours following oral intake and has several systemic effects including rapidly increasing epinephrine release, blood pressure, and insulin sensitivity. Caffeine has both systemic and cerebral vasoconstrictive effects. Volunteers taking oral caffeine (250-500 mg) demonstrate a rapid reduction in cerebral perfusion within 30 to 90 minutes. Partial tolerance of the effects of coffee on the cardiovascular system develops after only 1 week. Mostofsky et al. found attenuation of the acute risk of ischemic stroke following consumption of caffeinated coffee among those reporting higher levels of habitual coffee consumption similar to previously reported data on risk of myocardial infarction.9 Thus, coffee may increase the risk of stroke in na�ve coffee drinkers but not in long-term users

Lord KC; Shenouda SK; McIlwain E; Charalampidis D; Lucchesi PA; Varner KJ. Oxidative stress contributes to methamphetamine-induced left ventricular dysfunction. Cardiovascular Research 87(1): 111-118, 2010. (34 refs.)

Our aim was to test the hypothesis that the repeated, binge administration of methamphetamine would produce oxidative stress in the myocardium leading to structural remodeling and impaired left ventricular function. Echocardiography and Millar pressure-volume catheters were used to monitor left ventricular structure and function in rats subjected to four methamphetamine binges (3 mg/kg, iv for 4 days, separated by a 10-day drug-free period). Hearts from treated and control rats were used for histological or proteomic analysis. When compared with saline treatment, four methamphetamine binges produced eccentric left ventricular hypertrophy. The drug also significantly impaired systolic function (decreased fractional shortening, ejection fraction, and adjusted maximal power) and produced significant diastolic dysfunction (increased -dP/dt and tau). Dihydroethedium staining showed that methamphetamine significantly increased (285%) the levels of reactive oxygen species in the left ventricle. Treatment with methamphetamine also resulted in the tyrosine nitration of myofilament (desmin, myosin light chain) and mitochondrial (ATP synthase, NADH dehydrogenase, cytochrome c oxidase, prohibitin) proteins. Treatment with the superoxide dismutase mimetic, tempol in the drinking water prevented methamphetamine-induced left ventricular dilation and systolic dysfunction; however, tempol (2.5 mM) did not prevent the diastolic dysfunction. Tempol significantly reduced, but did not eliminate dihydroethedium staining in the left ventricle, nor did it prevent the tyrosine nitration of mitochondrial and contractile proteins. This study shows that oxidative stress plays a significant role in mediating methamphetamine-induced eccentric left ventricular dilation and systolic dysfunction.

Luigetti M; Cianfoni A; Conte A; Colosimo C; Tonali PA; Sabatelli M. Posterior ischaemic myelopathy associated with cocaine abuse. (editorial). Internal Medicine Journal 40(10): 732-733, 2010. (2 refs.)

Mahalik JR; Burns SM. Predicting health behaviors in young men that put them at risk for heart disease. Psychology of Men & Masculinity 12(1): 1-12, 2011. (49 refs.)

There were 161 young adult men who completed measures assessing their health beliefs, masculinity, perceptions of the normativeness of health behaviors in other men, and heart healthy behaviors (i.e., diet, exercise, alcohol abuse, tobacco use, and medical screenings). Men's heart-healthy behaviors were predicted by beliefs of benefits to healthy behavior, barriers, health knowledge, normativeness of men's health-promoting behavior, and interaction between masculinity and barriers. The discussion addresses how the Health Belief model applied to men's heart healthy behaviors may be enhanced through greater consideration of sociocontextual variables such as gender role conformity and social norms. The authors suggest that future research might address multi-modal interventions aimed at improving men's heart health that address both beliefs and men's social context.

Masoumi M; Shahesmaeili A; Mirzazadeh A; Tavakoli M; Ali AZ. Opium addiction and severity of coronary artery disease: A case-control study. Journal of Research in Medical Sciences 15(1): 27-32, 2010. (21 refs.)

BACKGROUND: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the world. Determination of the risk factors and high risk groups plays an important role in the prevention and controlling programs. The present study aims to determine the relationship between opium consumption and severity of CAD. METHODS: In this hospital based case-control study, 299 patients who were candidates for coronary angiography from 2006 to 2007 were recruited. The patients' history of opium addiction was taken. Based on their history. they were categorized into three groups: non users, occasional users and Current users. The relationship between opium addiction and severity of CAD was analyzed by a multiple logistic regression model, STATA v. 10. RESULTS: According to angiographic data, patients were divided into 3 groups: 84 patients (28.09%) as non coronary artery disease, 81 patients (27.09%) as mild CAD and the remaining 134 patients (44.82%) as severe CAD. Univariate analysis showed that current opium users had higher odds of severe CAD compared with non users. Multivariate analysis showed a significant relationship between age, diabetes, hyperlipidemia, gender and severity of coronary artery stenosis. CONCLUSIONS: The findings indicated that current Opium users - in comparison with non users - have a higher risk for severe CAD. But it is roughly confounded by other co-factors such as cigarette smoking, age and sex. A dose-response was noticed between the type of opium consumption and the severity of CAD.

May R; Tofler GH; Bartrop R; Heinrich P; Baird J; Jozefiak E et al. Smoking cessation through a novel behavior modification technique. American Journal of Cardiology 106(1): 44-46, 2010. (15 refs.)

Smoking remains a major public health problem. Experiencing a myocardial infarction (MI) can be a teachable moment that results in smoking cessation when previous efforts have failed. We tested the feasibility of providing a simulated and personalized experience of an MI to facilitate quitting smoking. Smokers, who were recruited from the community, had photographs taken of themselves, their partner, and family. These photographs were inserted into a video depicting the subject as a smoker experiencing an MI with potential consequences to themselves (death or disability) and their family. The subject watched the video and a psychologist used motivational interviewing to reinforce quitting efficacy. Thirteen subjects (11 men, 2 women) 45 12 years of age with no smoking-related illness and a nonsmoking partner were studied. At week 1, 7 of 13 subjects (54%) reported stopping smoking, and the other 6 had decreased consumption. Daily cigarette consumption at week 1 decreased from 17.3 +/- 9.3 at baseline to 2.7 +/- 4.9 (p <0.005) and expired carbon monoxide levels from 15.7 +/- 9 to 3.1 +/- 3.2 parts per million (p <0.005). Seven subjects had observable responses to the video including "looking uncomfortable" and "red eyes, difficulty speaking." Self-reports included "made me aware of the important things" and "it felt very real." At 6 months, 7 of 13 subjects (54%) were still abstinent. Five of the 7 nonsmoking subjects used an additional antismoking aid. In conclusion, it is feasible to create a simulated and personalized teachable moment and these findings provide encouragement for evaluating this novel method for smoking cessation and other behavior modifications.

Mazzone P; Tierney W; Hossain M; Puvenna V; Janigro D; Cucullo L. Pathophysiological impact of cigarette smoke exposure on the cerebrovascular system with a focus on the blood-brain barrier: Expanding the awareness of smoking toxicity in an underappreciated area. (review). International Journal of Environmental Research and Public Health 7(12): 4111-4126, 2010. (98 refs.)

Recent evidence has indicated that active and passive cigarette smoking are associated, in a dose-dependent manner, with dysfunction of normal endothelial physiology. Tobacco smoke (TS) may predispose individuals to atherogenic and thrombotic problems, significantly increasing the risk for ischemic manifestations such as acute coronary syndrome and stroke. Despite the strong evidence for an association between smoking and vascular impairment, the impact of TS exposure on the blood-brain barrier (BBB) has only been marginally addressed. This is a major problem given that the BBB is crucial in the maintenance of brain homeostasis. Recent data have also shown that chronic smokers have a higher incidence of small vessel ischemic disease (SVID), a pathological condition characterized by leaky brain microvessels and loss of BBB integrity. In the brain TS increases the risk of silent cerebral infarction (SCI) and stroke owing to the pro-coagulant and atherogenic effects of smoking. In this article we provide a detailed review and analysis of current knowledge of the pathophysiology of tobacco smoke toxicity at the cerebrovascular levels. We also discuss the potential toxicity of recently marketed "potential-reduced exposure products".

Mineharu Y; Koizumi A; Wada Y; Iso H; Watanabe Y; Date C; p. Coffee, green tea, black tea and oolong tea consumption and risk of mortality from cardiovascular disease in Japanese men and women. Journal of Epidemiology and Community Health 65(3): 230-240, 2011. (39 refs.)

Background: The effects of coffee and green, black and oolong teas and caffeine intake on cardiovascular disease (CVD) mortality have not been well defined in Asian countries. Methods To examine the relationship between the consumption of these beverages and risk of mortality from CVD, 76 979 individuals aged 40-79 years free of stroke, coronary heart disease (CHD) and cancer at entry were prospectively followed. The daily consumption of beverages was assessed by questionnaires. Results: 1362 deaths were documented from strokes and 650 deaths from CHD after 1 010 787 person-years of follow-up. Compared with non-drinkers of coffee, the multivariable HR and 95% CI for those drinking 1-6 cups/week, 1-2 cups/day and >= 3 cups/day were 0.78 (0.50 to 1.20), 0.67 (0.47 to 0.96) and 0.45 (0.17 to 0.87) for strokes among men (p=0.009 for trend). Compared with non-drinkers of green tea, the multivariable HR for those drinking 1-6 cups/week, 1-2 cups/day, 3-5 cups/day and >= 6 cups/day were 0.34 (0.06-1.75), 0.28 (0.07-1.11), 0.39 (0.18-0.85) and 0.42 (0.17-0.88) for CHD among women (p=0.038 for trend). As for oolong tea, the multivariable HR of those drinking 1-6 cups/week and >= 1 cups/day were 1.00 (0.65-1.55) and 0.39 (0.17-0.88) for total CVD among men (p=0.049 for trend). Risk reduction for total CVD across categories of caffeine intake was most prominently observed in the second highest quintile, with a 38% lower risk among men and 22% among women. Conclusions: Consumption of coffee, green tea and oolong tea and total caffeine intake was associated with a reduced risk of mortality from CVD.

Moraros J; Bird Y; Chen S; Buckingham R; Meltzer RS; Prapasiri S et al. The impact of the 2002 Delaware smoking ordinance on heart attack and asthma. International Journal of Environmental Research and Public Health 7(12): 4169-4178, 2010. (22 refs.)

In the United States, smoking is the leading cause of death - having a mortality rate of approximately 435,000 people in 2000-accounting for 8.1% of all US deaths recorded that year. Consequently, we analyzed the Delaware Hospital Discharge Database, and identified state and non-state residents discharged with AMI or asthma for the years 1999 to 2004. Statistical data analysis compared the incidence of AMI or asthma for each group before (1999-2002) and after (2003-2004) the amendment. As a result, we found that pre-ordinance and post-ordinance quarterly rates of AMI for Delaware residents were 451 (se = 21) and 430 (se = 21) respectively, representing a 4.7% reduction. Over the same time period, there was negligible change in the incidence of AMI for non-Delaware residents. After adjusting for population growth, the Risk Ratio (RR) for asthma in Delaware residents post-ordinance was 0.95 (95% CI, 0.90 to 0.999), which represented a significant reduction (P = 0.046). By comparison, non-Delaware residents had an increased RR for asthma post-ordinance of 1.62 (95% CI, 1.46 to 1.86; P < 0.0001). The results suggest that Delaware's comprehensive non-smoking ordinance effectively was associated with a statistically significant decrease in the incidence of AMI and asthma in Delaware residents when compared to non-Delaware residents.

Oyama J; Maeda T; Sasaki M; Kozuma K; Ochiai R; Tokimitsu I et al. Green tea catechins improve human forearm vascular function and have potent anti-inflammatory and anti-apoptotic effects in smokers. Internal Medicine 49(23): 2553-2559, 2010. (37 refs.)

Objective: Several epidemiological investigations have reported that green tea reduces cardiovascular and cerebral vascular risks. Green tea catechins may improve peripheral endothelial dysfunction in smokers. The purpose of this study was to elucidate the beneficial effect of green tea catechins on the repair of endothelial dysfunction in smokers. Methods Thirty healthy male smokers divided into three groups ingested a green tea beverage containing 0 mg (control group), 80 mg (middle dose group) or 580 mg (high dose group) of green tea catechins (GTC) daily for two weeks, and endothelial-dependent vasodilatation was investigated by measuring forearm blood flow (FBF) response to reactive hyperemia (RH) by venous occlusion strain-gauge plethysmography. Results: An acute effect was that the FBF response to RH significantly increased 2 hr after GTC intake in the high dose group. However, no increase was observed in the other groups. The chronic administration of GTC for one or two weeks ameliorated the FBF responses to RH in the high dose group. On the other hand, no significant increase was observed in the FBF responses to RH in the other groups. Moreover, the plasma concentration of 8-OHdG, IL-6, TNF-alpha, and soluble Fas decreased significantly for two weeks in the high dose group, however, the level of IL-1 beta remained unchanged over this period. Conclusion: Green tea consumption over short and long periods appears to ameliorate endothelial dysfunction by scavenging free radicals with anti-inflammatory and anti-apoptotic properties in healthy male smokers.

Parikh R; Hussain T; Holder G; Bhoyar A; Ewert AK. Maternal methadone therapy increases QTc interval in newborn infants. Archives of Disease in Childhood. Fetal and Neonatal Edition 96(2): F141-F143, 2011. (19 refs.)

Introduction Prolongation of the QT interval is a risk factor for sudden death. Methadone treatment is a well-recognised cause of QT interval lengthening in adults. The effect of maternal methadone treatment on the QT interval of the newborn infant is not known. This is the first prospective study of corrected QT (QTc) interval in infants born to mothers receiving methadone. Aim To compare QTc interval in infants born to mothers receiving methadone therapy with healthy controls. Method Twenty-six term infants (median gestation 38 weeks, range 37-40) born to mothers on methadone therapy had ECG recordings on days 1, 2, 4 and 7. The QTc interval was calculated using the Bazzett formula. Results for days 1 and 2 were compared with healthy matched control infants born to mothers who were not receiving methadone. Results for days 4 and 7 were compared with published normal values. Results In the methadone group, the QTc interval was significantly prolonged on days 1 and 2 of life. On days 4 and 7, this increase was no longer present. None of the infants in either group had any evidence of significant cardiac rhythm disturbance. Conclusion Maternal methadone therapy can cause transient prolongation of the QTc interval in newborn infants in the first 2 days of life. Newborns exposed to methadone are at risk of cardiac rhythm disturbances. Bradycardia, tachycardia or an irregular heart rate in an infant born to a mother on methadone treatment should prompt investigation with a 12-lead ECG.

Pieper B; Templin TN; Kirsner RS; Birk TJ. Injection-related venous disease and walking mobility. Journal of Addictive Diseases 29(4): 481-492, 2010. (58 refs.)

Injection users are at risk for vascular injuries resulting in chronic venous disease (CVD). The authors examined walking mobility in relation to CVD for 713 individuals in methadone treatment. The authors used a cross-sectional, comparative design that was stratified on age, sex, ethnicity, and drug use. CVD was present in 92.3% of participants. The structural equation model supported the causal link between leg injection and CVD (.40, P.001). The worse the mobility, the greater was the CVD classification (-.21, P.001). CVD had an indirect effect on mobility through pain. CVD and pain need to be considered when assessing mobility in illicit drug users.

Pieper B; Templin TN; Kirsner RS; Birk TJ. The impact of vascular leg disorders on physical activity in methadone-maintained adults. Research In Nursing & Health 33(5): 426-440, 2010. (51 refs.)

Chronic venous disorders (CVD) and peripheral arterial disease (PAD) may affect diverse physical activity domains. How CVD and PAD and other relevant variables affect physical activity was examined in 569 opioid-addicted adults. Both CVD and PAD were significantly inversely related to daily walking, sports, and active living. Effects remained significant in the latent variable regression after controlling covariates. Overall activity was very low; most participants walked less than a half mile daily and rarely engaged in sports. Motivation for physical activity was the strongest predictor (beta=.55) of daily physical activity. Health-care professionals promoting physical activity for iniection users should consider the vascular health of their legs and motivational variables in addition to general health.

Pipe AL; Papadakis S; Reid RD. The role of smoking cessation in the prevention of coronary artery disease. Current Atherosclerosis Reports 12(2): 145-150, 2010. (50 refs.)

Smoking (tobacco addiction) is the most significant of the modifiable cardiovascular risk factors. Mistakenly described as a "habit" or "behavioral choice," the onset of tobacco addiction quickly follows the acquisition of an ability to inhale cigarette smoke and is reflected in a transformation of neurophysiologic function and nicotine-receptor density. Thereafter, comfort and a degree of neurophysiologic "equanimity" require the regular administration of nicotine. Smokers inhale thousands of other chemicals, many of which play critical roles in the initiation and accentuation of atherosclerosis by influencing vasomotor activity, vascular dysfunction, oxidation of lipids, atheroma development, and thrombosis. Smoking cessation is a priority in the management of any patient with cardiovascular disease. The benefits of cessation accrue rapidly in such patients and have a pronounced effect on the likelihood of disease progression, hospital readmission, and mortality. All physicians must be familiar with the principles of cessation practice and be able to initiate smoking cessation attempts.

Power C; Atherton K; Thomas C. Maternal smoking in pregnancy, adult adiposity and other risk factors for cardiovascular disease. Atherosclerosis 211(2): 643-648, 2010. (30 refs.)

Objective: To establish whether maternal smoking in pregnancy is associated with risk factors for cardiovascular disease (CVD) in mid-adulthood and whether associations are explained by postnatal influences. Methods: Participants were 8815 men and women in the 1958 British birth cohort, with data on CVD risk factors measured at 45 y. Maternal smoking was recorded at birth. Results: Offspring of smokers had a higher adult BMI, waist circumference, blood pressure, HbA1c and triglycerides on average than offspring of non-smokers; females had lower HDL cholesterol levels. Total cholesterol was unrelated to maternal smoking. Associations were abolished after adjustment for postnatal influences across life, except for BMI and waist circumference: offspring of smokers had a BMI greater by 0.83 kg/m(2) on average than offspring of non-smokers and a 1.8cm larger waist circumference. Mean BMI and waist circumference increased with number of cigarettes that the mother smoked, but were not elevated in offspring whose mother had quit smoking before or early in pregnancy. Conclusions: Adults exposed to tobacco in utero had a more adverse CVD risk profile in mid-adulthood which appeared to reflect a lifetime accumulation of postnatal influences; whereas their higher BMI and central adiposity may be due in part to intrauterine mechanisms.

Reis JP; Loria CM; Steffen LM; Zhou X; van Horn L; Siscovick DS et al. Coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood and atherosclerosis later in life: The CARDIA Study. Arteriosclerosis, Thrombosis, and Vascular Biology 30(10): 2059-2066, 2010. (53 refs.)

Objective-To determine the association of coffee, decaffeinated coffee, caffeine, and tea consumption in young adulthood with the presence and progression of coronary artery calcified (CAC) plaque and carotid intima-media thickness later in life. Methods and Results-The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a cohort of 5115 white and black adults who were aged 18 to 30 years when they completed a baseline clinic examination from 1985 to 1986. Subsequent examinations were conducted 2, 5, 7, 10, 15, and 20 years later. After multivariable adjustment, no association was observed between average coffee, decaffeinated coffee, or caffeine consumption (years 0 and 7) and presence of CAC (score, >0 Agatston units at year 15 or 20), CAC progression (incident CAC at year 20 or increase in CAC score by >= 20 Agatston units), or high carotid intima-media thickness (>80th percentile, year 20). However, tea consumption displayed a nonsignificant trend for an inverse association with CAC (P = 0.08 for trend) and an inverse association with CAC progression (P = 0.04 for trend) but no association with high carotid intima-media thickness (P > 0.20 for trend). Stratification of the coffee analyses by sex, race, or smoking yielded similar nonsignificant patterns. Conclusion-We observed no substantial association between coffee or caffeine intake and coronary and carotid atherosclerosis. However, our results suggested an inverse association between tea and CAC but not carotid atherosclerosis.

Roux A; Motreff P; Perriot J; Pereira B; Lusson JR; Duale C et al. Early improvement in peripheral vascular tone following smoking cessation using nicotine replacement therapy: Aortic wave reflection. Cardiology 117(1): 37-43, 2010. (28 refs.)

Objectives: Cigarette smoking induces cardiovascular pathology and worsens arterial stiffness. Arterial stiffness can be assessed noninvasively based on 2 indices: pulse-wave velocity (PWV), indicating aortic stiffness, and the augmentation index (AIx), indicating aortic wave reflection. The impact of smoking cessation (SC) with nicotine replacement therapies (NRT) on arterial stiffness remains unknown. Methods: AIx and PWV were studied prospectively (using a SphygmoCor system) in 26 long-term smokers (>10 cigarettes/day; mean age 43 +/- 6 years) before (visit 1) and 28 and 56 days (visit 2 and visit 3) after SC supported by NRT. Abstinence was ascertained when exhaled carbon monoxide (CO) was <10 ppm; the quantity of NRT absorbed was assessed based on the serum cotinine level. Results: Sixteen of 24 patients (67%) were abstinent at the end of the study; 8/24 had cut down on smoking, and 2 were lost to follow-up. CO and serum cotinine levels fell after SC. The mean AIx for the population as a whole was 23.4% at visit 1, with a significant early reduction by visit 2 (16.2%) and visit 3 (13.9%) (ANOVA, p < 0.001). The PWV, peripheral blood pressure, and heart rate were unchanged. Conclusions: The improvement in AIx and the stability of PWV after SC with NRT indicate improved peripheral vascular tone. This impact may account for the early clinical benefit of SC observed even when associated with NRT.

Schmid K; Schonlebe J; Drexler H; Mueck-Weymann M. The effects of cannabis on heart rate variability and well-being in young men. Pharmacopsychiatry 43(4): 147-150, 2010. (17 refs.)

Introduction: The effects of cannabis use on the autonomic regulation of the heart had been identified in tests with volunteers. We studied these effects of cannabis use on young adults in everyday life. Methods: We measured heart rate variability (HRV) and well-being (WHO-5 score) in young men during a routine medical examination. Seventy-two men were identified with a positive drug screening test solely for tetrahydrocannabinol. The comparison group consisted of 72 men, matched according to age and body mass index, who used no illicit drugs or pharmaceuticals. Results: In the cannabis group, HRV was significantly increased compared to the control group. The median value of root mean square of successive differences (RMSSD) at rest was 56.2 ms in the drug users and 48.6 ms in the controls (p < 0.05). The ratio of low-to-high frequency was higher in the controls (median 1.87 vs. 1.62; p < 0.05). Psychological well-being, measured by WHO-5 score was significantly lower in cannabis users. Discussion: Our data support the hypothesis that the use of cannabis leads to a change in cardiovascular sympathovagal balance.

Schwartz BG; Rezkalla S; Kloner RA. Cardiovascular effects of cocaine. (review). Circulation 122(24): 2558-2569, 2010. (119 refs.)

The use of cocaine has evolved from chewing the leaves of the Erythroxylon coca bush thousands of years ago, to purification of cocaine hydrochloride over 100 years ago and its use in tonics and elixirs (at one time in popular cola drinks), to insufflating and injecting the fine, white, water-soluble, powder form, to a smokable freebase form called "crack," which became popular in the 1980s. In 2007, 2.1 million Americans had recent cocaine use; 1.6 million met criteria for cocaine dependence or abuse.1 Cocaine accounted for 31% of all visits to the emergency department related to drug misuse or abuse.1 From 1971 to 1987, the incidence of deaths caused by cocaine overdose increased 20-fold in Dade County, Florida. In a consecutive series of 233 emergency visits by cocaine-using patients, 56% presented with cardiovascular complaints, including 40% with chest pain. A minority of these patients have acute myocardial infarction (MI) ([almost equal to]6%), and overall mortality is low (<1%). However, cocaine is associated with a number of cardiovascular diseases, including MI, heart failure, cardiomyopathies, arrhythmias, aortic dissection, and endocarditis. Identifying patients with acute disease is challenging. This review describes the relationship between cocaine and various cardiovascular diseases, as well as appropriate diagnostic evaluation and therapies.

Seder DB; Schmidt JM; Badjatia N; Fernandez L; Rincon F; Claassen J et al. Transdermal nicotine replacement therapy in cigarette smokers with acute subarachnoid hemorrhage. Neurocritical Care 14(1): 77-83, 2011. (48 refs.)

We evaluated the safety of nicotine replacement therapy (NRT) in active smokers with acute (aneurysmal) subarachnoid hemorrhage (SAH). A retrospective observational cohort study was conducted in a prospectively collected database including all SAH patients admitted to an 18-bed neuro-ICU between January 1, 2001 and October 1, 2007. Univariate and multivariable models were constructed, employing stepwise logistic regression. The primary endpoint was 3-month mortality. Delayed cerebral ischemia (DCI) due to vasospasm, angiographic and TCD evidence of vasospasm, and delirium were secondary endpoints. Active cigarette smokers admitted with SAH included 128 that received NRT and 106 that did not. Patients were well-matched for age, admission Hunt-Hess Grade, radiographic findings, and APACHE II scores, but those who received NRT were more likely to be heavy smokers (> 10 cigarettes daily), diabetic, heavy alcohol users, and to have cerebral edema on admission. NRT was associated in multivariate analysis with a lower risk of death at 3 months (OR 0.12, 95% CI 0.04-0.37, P < 0.001). There were no differences in the frequency of DCI and most other medical complications, but delirium (19 vs. 9%, P = 0.006) and seizures (9 vs. 2%, P = 0.024) were more common in patients who received NRT. Despite vasoactive properties, administration of NRT among active smokers with acute SAH appeared to be safe, with similar rates of vasospasm and DCI, and a slightly higher rate of seizures. The association of NRT with lower mortality could be due to chance, to uncontrolled factors, or to a neuroprotective effect of nicotine in active smokers hospitalized with SAH, and should be tested prospectively.

Shah AM; Pfeffer MA; Hartley LH; Moye LA; Gersh BJ; Rutherford JD et al. Risk of all-cause mortality, recurrent myocardial infarction, and heart failure hospitalization associated with smoking status following myocardial infarction with left ventricular dysfunction. American Journal of Cardiology 106(7): 911-916, 2010. (26 refs.)

Patients with left ventricular (LV) systolic dysfunction after myocardial infarction (MI) are at particularly high risk for recurrent adverse outcomes. The magnitude of the decrease in risk associated with smoking cessation after MI has not been well described in patients with LV dysfunction after MI. We aimed to quantify the risk decrease associated with smoking cessation in subjects with LV dysfunction after MI. The Survival and Ventricular Enlargement (SAVE) trial randomized 2,231 subjects with LV dysfunction 3 to 16 days after MI. Smoking status was assessed at randomization and at regular intervals during a median follow-up of 42 months. Propensity score-adjusted Cox proportional hazard models were used to quantify the decrease in risk of all-cause mortality, death or recurrent MI, and death or heart failure (HF) hospitalization associated with smoking cessation. In baseline smokers who survived to 6 months without interval events, smoking cessation at 6-month follow-up was associated with a significantly lower adjusted risk of all-cause mortality (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.31 to 0.91), death or recurrent MI (HR 0.68, 95% CI 0.47 to 0.99), and death or HF hospitalization (HR 0.65, 95% CI 0.46 to 0.92). In conclusion, in patients with LV dysfunction after MI, smoking cessation is associated with a 40% lower hazard of all-cause mortality and a 30% lower hazard of death or recurrent MI or death or HF hospitalization. These findings indicate that smoking cessation is beneficial after high-risk MI and highlight the importance of smoking cessation as a therapeutic target in patients with LV dysfunction after MI.

Shimada S; Hasegawa K; Wada H; Terashima S; Satoh-Asahara N; Yamakage H et al. High blood viscosity is closely associated with cigarette smoking and markedly reduced by smoking cessation. Circulation Journal 75(1): 185-189, 2011. (14 refs.)

Background: Cigarette smoking is an independent risk factor for cardiovascular events such as myocardial infarction and stroke. To date, a useful and convenient method of predicting such events in smokers has not been established. The rheological properties of blood assessed by the microchannel method reflect the blood's viscosity and the state of microthrombus formation, which may predict cardiovascular thrombotic events. Methods and Results: Blood fluidity was assessed in 74 smoking patients (54 men, 20 women, mean age 57.9 years) by measuring the blood passage time (BPT) in an aliquot (100 mu l) of blood using the Micro Channel Array Flow Analyzer. BPT was significantly related with smoking variables such as daily consumption of tobacco (r=0.236, P=0.044), Brinkman's index (r=0.252, P=0.033), the Fagerstrom Test for Nicotine Dependence (r=0.257, P=0.029), and the score of a self-rating depression scale (r=0.236, P<0.05). Multivariate regression analysis revealed that an independent BPT determinant was daily consumption of tobacco (r=0.326, P=0.045). Furthermore, smoking cessation markedly decreased BPT from 63.0 s to 49.7 s (P=0.002) at 3 months after the start of therapy. Conclusions: Unfavorable blood rheology is closely associated with cigarette smoking and may reflect increased cardiovascular risk in smokers. The study results also suggest that such risk can be reduced after only 3 months of smoking cessation.

Sicinska-Werner T; Medras M. Hormonal status, tobacco addiction, and coronary arteriosclerosis in 40-to 60-year-old non-diabetic men. Advances in Clinical and Experimental Medicine 19(2): 211-218, 2010. (21 refs.)

Background. Tobacco addiction undoubtedly plays a major role in coronary atherosclerosis formation in men. An age-related decrease in androgenic hormones is probably also involved. Since the coexistence of diabetes dramatically increases cardiovascular risk and mortality from these causes, it is important to study this issue in men without diabetes in assessing the impact of hormonal changes and tobacco consumption on atherogenesis. Objectives. Assessment of impact of hormonal changes and tobacco consumption on artheriosclerosis in the coronary arteries in non-diabetic men aged 40-60. Material and Methods. One hundred two men, including 62 smokers, aged 40-60 years without diabetes in whom angiography due to cardiac indications was performed were involved in the study. From this group, subgroups of patients, 42 with coronary atherosclerosis and 20 without changes in coronary angiography, were established. A control group of 40 healthy men with a negative medical history and normal physical examination and exercise test included 20 smokers and 20 nonsmokers. The concentrations of total and free testosterone, calculated free and bioavailable testosterone, SHBG, DHEAS, E-2, IGF-1, GH, and the free androgen index (FAI) were studied in the men. Hormonal status and tobacco addiction parameters were compared with atherogenesis development in the coronary arteries. Results. The presence of atherosclerosis in the coronary arteries correlated with increased tobacco consumption, reduced concentration of free testosterone (assessed by an RIA test), and increased SHBG compared with the men without atherosclerosis. Smokers with atherosclerosis of the coronary arteries also showed lower levels of DHEAS than the healthy smokers and higher LH than the healthy nonsmokers. There were no differences in the mean concentrations of total testosterone, FAI, free and calculated bioavailable testosterone, estradiol, growth hormone, and IGF-1 in the studied groups. No relationship was observed between hormone levels tested with the parameters characterizing tobacco addiction and the degree of coronary occlusion assessed with the number of significantly stenosed vessels and the Gensini score. Conclusions. Coronary atherosclerosis in men is associated with smoking and lower concentrations of free testosterone and DHEAS. Lack of correlation of the other hormone levels with the parameters of tobacco addiction and the degree of vascular occlusion confirmed that the etiology of coronary heart disease is multifactorial.

Silva RR; Skimming JW; Muniz R. Cardiovascular safety of stimulant medications for pediatric attention-deficit hyperactivity disorder. Clinical Pediatrics 49(9): 840-851, 2010. (62 refs.)

Attention-deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder that is often treated with stimulants such as methylphenidate and mixed amphetamine salts. Despite their efficacy and long history of use, there is concern about their potential for adverse cardiovascular effects in children and adolescents. Data from placebo-controlled and open-label extension trials published after 2000 were reviewed, and cardiovascular adverse event data were compared. Both placebo-controlled and open-label extension trials have repeatedly shown stimulant-induced increases in mean blood pressure, heart rate, and QT interval in children, adolescents, and adults. Although these increases seem relatively minor, their existence raises questions regarding whether stimulants could influence the likelihood of sudden death or other serious cardiovascular consequences, especially in patients with underlying heart problems. Moreover, questions have been raised regarding the necessity of screening patients for occult or unrecognized heart problems that are felt to be adversely affected by stimulant use. Obtaining a baseline electrocardiogram for any patient starting stimulant treatment is reasonable if access to such screening is readily available and not too costly.

Tatli E; Aktoz M. Heroin abuse and myocardial infarction. Trakya Universitesi Tip Fakultesi Dergisi 27(2): 212-214, 2010. (9 refs.)

Information concerning acute myocardial infarction after heroin usage is limited and the actual mechanism of heroin-induced myocardial infarction is not well known. Only one report has been described noting the association between usage heroin and acute myocardial infarction in a young man with normal coronary arteries. We also reported a patient with normal coronary arteries and acute myocardial infarction after heroin abuse.

Toossi S; Hess CP; Hills NK; Josephson SA. Neurovascular complications of cocaine use at a tertiary stroke center. Journal of Stroke & Cerebrovascular Diseases 19(4): 273-278, 2010. (29 refs.)

Objective: An association between cocaine use and stroke has been reported, but few studies have examined cocaine-related neurovascular disease using modern stroke diagnostic techniques. We describe a large cohort of patients with cocaine-related stroke to define the pathophysiology and manifestations of cocaine-related neurovascular disease. Methods: All adult admissions to a tertiary neurovascular service from July 1, 1998 to July I, 2008 were screened for evidence of current or previous cocaine use. Patients included underwent thorough review of medical records including diagnostic procedure, laboratory, and imaging results. Results: A total of 5142 records were screened and 96 patients were identified; 45 (47%) were given the diagnosis of ischemic stroke/transient ischemic attack (TIA), 26 (27%) with intracerebral hemorrhage (ICH), and 25 (26%) with subarachnoid hemorrhage. In all, 61(63.5%) patients were categorized as active and 35 (36.5%) as previous cocaine users. Stroke type differed significantly between active and prior users (P = .004), with active users more likely to have ICH compared with previous users (37.7% v 8.6%) and less likely to have ischemic stroke or TIA (36.1% v 65.7%). The most common stroke/TIA cause was large artery atherosclerosis in 20 (44%) patients. Of the 25 subarachnoid hemorrhage cases, 22 (88%) were aneurysmal. Conclusion: Ischemic stroke/TIA is a common neurovascular presentation in patients with a remote history of cocaine use, often as a result of atherosclerotic disease; neither vasculitis nor vasospasm was a common cause of stroke in this cohort. ICH is more common in those currently using cocaine perhaps because of acute spikes in blood pressure. Further prospective trials are needed to confirm these results.

Trachsel LD; Kuhn MU; Reinhart WH; Schulzki T; Bonetti PO. Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland. Swiss Medical Weekly 140(9-10): 133-138, 2010. (25 refs.)

Objective: On March 1(st), 2008 a smoking ban in public buildings became effective in the Canton of Graubuenden, Switzerland. The aim of our study was to investigate, whether implementation of this new regulation was followed by a decrease in the incidence of acute myocardial infarction (AMI). Patients and methods: The Kantonsspital Graubuenden serves as a tertiary care hospital, possessing the only cardiac catheterization laboratory in the Canton of Graubuenden. Based on an excellent functioning network including all hospitals in the Canton of Graubuenden, virtually all patients experiencing an AMI in the Canton of Graubuenden are transferred to our hospital for either acute or early coronary angiography. Data of all patients with AMI undergoing coronary angiography at our hospital between March 1(st), 2008 and February 28(th), 2009 were collected prospectively. The data were then compared with those of the two corresponding 12-month periods preceding implementation of the public smoking ban. Results: In the two years before adoption of smoke-free legislation, the number of patients with AMI was 229 and 242, respectively (p = ns). In the 12 months after implementation of the public smoking ban, the number of AMI patients dropped to 183 (p < 0.05 vs. each of the previous 12-month periods), representing an overall 22% reduction in the AMI incidence within the first year after enactment of the new regulation. This reduction was driven by a significant decrease in the AMI incidence in men, nonsmokers, and individuals with established coronary artery disease, including those with prior AMI or prior percutaneous coronary intervention. Conclusions: Similar to other countries in Europe and various regions of the USA and Canada, implementation of a public smoking ban was followed by a significant early decline in the incidence of AMI in the Canton of Graubuenden, Switzerland.

Tracy MB; Klimek J; Hinder M; Ponnampalam G; Tracy SK. Does caffeine impair cerebral oxygenation and blood flow velocity in preterm infants? Acta Paediatrica 99(9): 1319-1323, 2010. (30 refs.)

Aim: The aim of the study is to assess the effects of an intravenous 10 mg/kg loading dose of caffeine base in cerebral oxygenation, cerebral Doppler blood flow velocity and cardiac output in preterm infants. Methods: Preterm neonates < 34 weeks gestation were investigated at 1 and 4 h following the loading dose of caffeine using Doppler cerebral sonography, cardiac echocardiography and cerebral spatially resolved near-infrared spectroscopy. Results: Forty infants were studied with a mean gestational age (mean +/- standard deviation) of 27.7 (+/- 2.5) weeks, birth weight of 1155 (+/- 431) g and a postnatal age of 2.8 (+/- 2.2) days. Mean Anterior Cerebral Artery peak and time average mean blood flow velocity fell significantly by 14% and 17.7%, respectively at 1 h post-caffeine loading dose, which recovered partially by 4 h. Cerebral Tissue Oxygenation Index fell from pre-dose levels by 9.5% at 1 h with partial recovery to 4.9% reduced at 4 h post-dose. There were no significant changes in left or right ventricular output, transcutaneous oxygen saturation, transcutaneous PCO2 or total vascular resistance. Conclusions: A loading dose of 10 mg/kg caffeine base resulted in significant reduction at 1 h post-dose in cerebral oxygenation and cerebral blood flow velocity with partial recovery at 4 h.

Trovato GM; Pirri C; Martines GF; Trovato F; Catalano D. Coffee, nutritional status, and renal artery resistive index. Renal Failure 32(10): 1137-1147, 2010. (45 refs.)

Background: The relationship between nutrition and atherosclerosis is known, even dissociated from protein malnutrition. Cardiovascular impact of several nutrients is known; among them the action of coffee is still debated and cardiovascular effect of caffeine has been investigated without definite results. Objective: The aim of this study is to investigate whether coffee habits, and/or quantity of coffee consumption, have any relationship with renal resistive index (RRI), a hallmark of arterial stiffness (AS). The relationship of AS with nutritional status assessed by body composition and serum albumin, insulin resistance (assessed by HOMA), and renal function assessed by glomerular filtration rate (GFR) is concurrently investigated. Methods: This study was done with 221 consecutive patients, without diabetes, cancer, liver, renal, and heart disease, referred for clinical noninvasive assessment and nutritional counseling: 124 essential hypertensive and 97 nonhypertensive patients were eligible. Personalized Mediterranean diet, physical activity increase, and smoking withdrawal counseling were provided. Results: By multiple linear regression, fat-free mass (FFM), HOMA (positive relationship), and number of cups of coffee/day (negative relationship) account for 17.2% of the variance to RRI. By odds ratios lower risk to increased RRI is associated with higher serum albumin, higher hemoglobin, and FFM; greater risk is associated with hypertension, insulin resistance (HOMA >= 3.0), and renal insufficiency (GFR <= 90); coffee, assessed by number of cups/day, reduces risk. Conclusion: Coffee use is inversely associated with RRI. Habitual coffee users have risk protection to higher RRI; lower serum albumin, insulin resistance, and renal insufficiency are associated with greater RRI.

Tzankova V; Petrov V; Danchev N. Impact of oral contraceptives and smoking on arterial and deep venous thrombosis: A retrospective case-control study. Biotechnology & Biotechnological Equipment 24(3): 2026-2030, 2010. (25 refs.)

The scientific debate on oral contraceptives (OCs) therapy and thrombotic diseases continues unabated. This retrospective case-control study was intended to evaluate the age specific effects of oral contraceptives and smoking on the risk of deep venous thrombosis, pulmonary thromboembolism and arterial thombosis in women under 50 years. The study included evaluation of registry records of Bulgarian women discharged from the National Heart Hospital, Sofia from 2005 through 2009 after thromboembolic event. The relative risk of thrombotic disease was seen to increase with oral contraceptive use. The risk of arterial disease OR 3.6 (CI 1.3-6.8) exceeded those of venous disease OR 2.3 (CI 1.3-4.0). In the 2005-2009 data the relative risk of thrombotic diseases was seen to increase age-dependently The increase was exponential for arterial thrombosis, and linear for venous thromboembolism. The combination of smoking with oral contraceptives, containing low-dose ethinylestradiol (0.03 mg) and progestins may have synergistic effects on risks of arterial thromboembolism, and might aggravate venous thrombosis. Most probably different factors that favor vascular narrowing or occlusion might explain the association between deep venous thrombosis, pulmonary thromboembolism, OCs use and smoking. Women, especially older than 35 years, should be assessed for thrombogenic risk factors including smoking, hypertension, methabolic syndrome, and other vascular diseases prior to oral contraceptive use.

Virdis A; Giannarelli C; Neves MF; Taddei S; Ghiadoni L. Cigarette smoking and hypertension. (review). Current Pharmaceutical Design 16(23): 2518-2525, 2010. (99 refs.)

Cigarette smoking is a powerful cardiovascular risk factor and smoking cessation is the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases. Impairment of endothelial function, arterial stiffness, inflammation, lipid modification as well as an alteration of antithrombotic and prothrombotic factors are smoking-related major determinants of initiation, and acceleration of the atherothrombotic process, leading to cardiovascular events. Cigarette smoking acutely exerts an hypertensive effect, mainly through the stimulation of the sympathetic nervous system. As concern the impact of chronic smoking on blood pressure, available data do not put clearly in evidence a direct causal relationship between these two cardiovascular risk factors, a concept supported by the evidence that no lower blood pressure values have been observed after chronic smoking cessation. Nevertheless, smoking, affecting arterial stiffness and wave reflection might have greater detrimental effect on central blood pressure, which is more closely related to target organ damage than brachial blood pressure. Hypertensive smokers are more likely to develop severe forms of hypertension, including malignant and renovascular hypertension, an effect likely due to an accelerated atherosclerosis.

Vogiatzis I; Tsikrika E; Sachpekidis V; Pittas S; Kotsani A. Factors affecting smoking resumption after acute coronary syndromes. Hellenic Journal of Cardiology 51(4): 294-300, 2010. (40 refs.)

Introduction: Many patients who are hospitalised for acute ischaemic episodes stop smoking; however, many of them relapse and resume smoking again within three months from their hospitalisation. The aim of this study was to study the factors that might affect smoking resumption in patients who have suffered an acute coronary syndrome. Methods: We studied 420 patients, active smokers at the time of admission, who were hospitalised for an acute coronary episode. The patients' data (history, risk factors, smoking habits) were retrieved from their medical files. During their hospitalisation they were asked to stop smoking and to attend the smoking cessation clinic to be advised about this. The patients were followed for one year and logistic regression analysis was used to evaluate the independent predictors of smoking resumption and continuation. Results: Of the total patient population, 280 (66.67%) visited the smoking cessation clinic and followed a special programme. Most relapses were recorded during the first 3 months of follow up, after which time 223 (53.1%) were still smoking, compared with 256 (61.43%) at 1 year. Independent predictors of smoking resumption were: non-participation in the smoking cessation programme (odds ratio, OR: 4.32, p=0.0007); the use of antidepressants (OR: 2.28, p=0.01); a history of vascular disease (OR: 2.32, p=0.03); a history of chronic obstructive pulmonary disease (OR: 1.35, p=0.001; and a decree of nicotine dependency >8 on the Fagerstrom scale, as recorded in questionnaires (OR: 1.42, p=0.04). Conclusions: Smokers with acute coronary syndromes should be encouraged to participate in special secondary prevention programmes. Smoking cessation clinics contribute significantly to a reduction in smoking in this group of patients.

Wakabayashi I. Associations between alcohol drinking and multiple risk factors for atherosclerosis in smokers and nonsmokers. Angiology 61(5): 495-503, 2010. (40 refs.)

This study investigated relationships between alcohol intake and multiple risk factors for atherosclerosis in smokers and nonsmokers. Men aged 35 to 54 years (n = 27 005) were divided into 6 groups by ethanol intake. The prevalence of multiple (>= 3 or >= 4) risk factors, including obesity, high blood pressure, high total cholesterol, triglyceride and fasting blood glucose, and low high-density lipoprotein (HDL) cholesterol, was compared among the groups in smokers and nonsmokers. Smokers and nonsmokers showed U- and J-shaped relationships, respectively, between alcohol intake and prevalence of multiple risk factors. Odds ratios of drinkers versus nondrinkers for multiple risk factors were significantly low in very light, light, moderate, and heavy drinkers in smokers and were significantly low in light and moderate drinkers but not in very low and heavy drinkers in nonsmokers. There is a U-or J-shaped relationship between alcohol consumption and multiple risk factors for atherosclerosis, and this relationship is modified by smoking.

Westover AN; Nakonezny PA. Aortic dissection in young adults who abuse amphetamines. American Heart Journal 160(2): 315-321, 2010. (42 refs.)

Background: Case reports suggest a relationship between amphetamine abuse/dependence and aortic dissection, but no population-based epidemiologic studies have examined this link. Our objective was to test the hypothesis that young adults with a diagnosis of amphetamine abuse/dependence would be at higher risk for aortic dissection after accounting for known risk factors. Methods: In this population-based case-control study of 30,922,098 discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1995 to 2007, among persons aged 18 to 49 years, we identified 3,116 thoracic and thoracoabdominal aortic dissections using International Classification of Disease, Ninth Edition, Clinical Modification codes 441.01 and 441.03. The SURVEYLOGISTIC procedure in SAS 9.2 (SAS Institute, Cary, NC) was used to account for the Nationwide Inpatient Sample sampling methodology. Results: In a multiple logistic regression analysis, while controlling for known risk factors, amphetamine abuse/dependence was significantly associated with aortic dissection (adjusted odds ratio = 3.33, 95% CI = 2.37-4.69, P < .0001). Conclusions: This statistically significant association suggests that amphetamine abuse/dependence may play a role in aortic dissection in young adults in the United States.

Wikstrom AK; Stephansson O; Cnattingius S. Tobacco use during pregnancy and preeclampsia: Risk effects of cigarette smoking and snuff. Hypertension 55(5): 1254-1259, 2010. (30 refs.)

Preeclampsia is a leading cause of maternal and infant mortality and morbidity worldwide. Both Swedish snuff and cigarette smoke include nicotine, but combustion products accompany only smoking. The aims of this study were to compare the effects of Swedish snuff and cigarette smoking on preeclampsia risk and to estimate whether changes in tobacco habits during pregnancy affect the risk of developing term preeclampsia. We used information from the Swedish Birth Register on all singleton births in Sweden during the years 1999-2006 (n=612 712). Compared with nontobacco users, women who used snuff in early pregnancy had an adjusted odds ratio (OR) for preeclampsia of 1.11 (95% CI: 0.97 to 1.28). The corresponding ORs for light and heavy smokers were 0.66 (95% CI: 0.61 to 0.71) and 0.51 (95% CI: 0.44 to 0.58), respectively, with ORs lower for term than preterm preeclampsia. Compared with nontobacco users, women who smoked in early pregnancy but had quit smoking before late pregnancy (weeks 30 to 32) had an adjusted OR for term preeclampsia of 0.94 (95% CI: 0.83 to 1.08). The corresponding OR for women who did not use tobacco in early pregnancy but had started to smoke before late pregnancy was 0.65 (95% CI: 0.50 to 0.85). We conclude that tobacco combustion products rather than nicotine are the probable protective ingredients against preeclampsia in cigarette smoke. Because change of smoking habits during pregnancy influence risk, we further conclude that it is the smoking habits in the middle or late rather than in the beginning of pregnancy that seem to affect the risk of preeclampsia.

Xu DS; Hartman D; Ludrosky K; Campbell J; Starling RC; Taylor DO et al. Impact of donor high-risk social behaviors on recipient survival in cardiac transplantation. Transplantation 89(7): 873-878, 2010. (26 refs.)

Objective. To investigate the impact of cardiac donor participation in high-risk social behaviors (HRSBs) on recipient survival. Methods. Retrospective chart review queried cardiac transplantations performed at our institution from August 1994 to November 2007 involving donors known to have engaged in HRSBs. Kaplan-Meier methodology was used to analyze survival rates, and a Cox proportional hazards regression was performed to determine the impact of donor HRSBs on survival. Results. We identified 143 donors with social histories containing the following HRSBs: incarceration (n=69), unprofessional tattoos or piercings (n=44), alternative lifestyle practice (n=11), cocaine use (n=60), heroin smoking (n=6), marijuana use (n=79), oral narcotic abuse (n=20), and intravenous drug use (n=21). At the time of donation, viral screens detected 10 donors who were hepatitis B virus (HBV) positive, 11 donors who were hepatitis C virus (HCV) positive, and no donors who were positive for the HIV. One-year and 5-year survival were 92.2% and 84.4%, respectively. Cox regression analysis found only donor HCV infection to be associated with poorer recipient survival (P=0.14). Conclusion. Using cardiac allografts from high-risk donors who are serologically negative for viruses does not seem to impact recipient survival. There is a considerable risk for transmission of HBV and HCV when these are detected by pretransplant screens. However, if pretransplant screening does not discover donor HBV, HCV, or HIV infection, it is unlikely that subclinical disease transmission will occur.

Yatsuya H; Folsom AR. Risk of incident cardiovascular disease among users of smokeless tobacco in the Atherosclerosis Risk in Communities (ARIC) Study. American Journal of Epidemiology 172(5): 600-605, 2010. (25 refs.)

Use of smokeless tobacco in the United States has been relatively constant in recent years, as tobacco companies continue aggressive marketing campaigns. The health effects of smokeless tobacco use need further documentation. Thus, the authors examined whether current use of smokeless tobacco was associated with increased incidence of cardiovascular disease (CVD) in 14,498 men and women aged 45-64 years at baseline (1987-1989) in the Atherosclerosis Risk in Communities (ARIC) Study. There were 2,572 incident CVD events (myocardial infarction, coronary revascularization, coronary death, or stroke) during a median of 16.7 years of follow-up (maximum = 19.1 years). Current use of smokeless tobacco at baseline was associated with 1.27-fold greater CVD incidence (95% confidence interval: 1.06, 1.52) than was nonuse, independently of demographic, socioeconomic, and lifestyle and other tobacco-related variables. Past use of smokeless tobacco was not associated with CVD incidence. In conclusion, current use of smokeless tobacco was associated with increased risk of CVD incidence in ARIC cigarette nonsmokers. Current users of smokeless tobacco should be informed of its harm and advised to quit the practice. Current cigarette smokers should also be given sufficient information on safe, therapeutic methods of quitting which do not include switching to smokeless tobacco.

Young F; Capewell S; Ford ES; Critchley JA. Coronary mortality declines in the US Between 1980 and 2000: Quantifying the contributions from primary and secondary prevention. American Journal of Preventive Medicine 39(3): 228-234, 2010. (52 refs.)

Background: Coronary heart disease (CHD) mortality rates in the U.S. have halved since 1980. However, CHD remains a leading cause of death. The relative importance of secondary and primary prevention in explaining falls in coronary heart disease mortality is debated. Purpose: The aim of this study was to quantify the primary and secondary preventive contributions to the U.S. CHD mortality fall between 1980 and 2000. Methods: The IMPACT model was used to estimate contributions to the U.S. CHD mortality fall from risk factor declines in asymptomatic individuals (primary prevention) and in CHD patients (secondary prevention). Analyses were carried out in 2008. Results: Approximately 316,100 fewer deaths were attributable to risk factor declines: 64,930 in CHD patients (21%) and 251,170 in asymptomatic individuals (79%). Smoking declines accounted for approximately 8390 fewer deaths in CHD patients and for 46,315 fewer deaths in asymptomatic people. Cholesterol falls gave approximately 22,210 fewer deaths in CHD patients and 107,300 fewer deaths in asymptomatic people. Statins accounted for approximately 16,580 fewer deaths, that is, one sixth of this mortality fall. Systolic blood pressure declines accounted for approximately 34,330 fewer deaths among CHD patients and 97,555 fewer deaths in asymptomatic individuals. Antihypertensive medications accounted for approximately 23,845 fewer deaths. Conclusions: Half of the U.S. mortality fall in coronary heart disease between 1980 and 2000 was attributable to risk factor declines, with primary prevention producing substantially larger mortality reductions than secondary.

Zhang LN; Yang YM; Xu ZR; Gui QF; Hu QQ. Chewing substances with or without tobacco and risk of cardiovascular disease in Asia: A meta-analysis. Journal of Zhejiang University. Science B 11(9): 681-689, 2010. (23 refs.)

To assess whether people who ever use any form of chewing substance in Asia are at increased risk of cardiovascular disease (CVD). PubMed and ISI Web of Science were searched for relevant studies, with no limitation on language or study year. Studies were included if they provided quantitative estimate of the association between ever use of chewing substance and the occurrence of CVD. Two authors independently implemented inclusion criteria, abstracted study characteristics, and performed meta-analysis. Summary relative risks were estimated on the basis of a random effect model. We used Q statistic and Egger's test to examine heterogeneity across studies and potential publication bias, respectively. Eight eligible studies were included. The relative risk of CVD for ever using chewing substances with or without tobacco was 1.26 (95% confidence interval (CI) 1.12-1.40), which was unchanged when restricted to cohort studies [1.25 (1.08-1.42)] or cohort studies in Taiwan [1.31 (1.12-1.51)]. The summary relative risk for ischemic heart disease was 1.27 (1.02-1.52), and was lowered to 1.26 (0.85-1.67) after exclusion of a cross-sectional study. The overall relative risk for cerebrovascular disease was 1.32 (1.08-1.56). On the basis of the Taiwan data, the summary relative risk of CVD for betel (Areca catechu) chewing was 1.30 (1.17-1.44). Data on dose-response were limited to betel chewing in Taiwan, suggesting a relationship between risk of CVD and cumulative exposure. Two large cohorts in Taiwan reported a greater risk of CVD with betel chewing than with smoking. An association was detected between betel chewing with or without tobacco and the risk of CVD. Betel chewing may impose a greater CVD risk than smoking. More effort is needed in developing betel chewing cessation programmes. The relationship between betel chewing and subgroups of CVD requires further investigation.