Acute Reduction in Ankle/Brachial Index Following Smoking in Chronic Smokers with Peripheral Arterial Occlusive Disease

Abstract

The ankle-brachial systolic pressure index (ABI), a noninvasive measure of peripheral arterial occlusive disease (PAOD) severity, is considered a marker of atherosclerosis and an independent predictor of mortality. However, it is not known whether factors other than PAOD severity, such as cigarette smoking, have an effect on ABI measurement. Therefore, the authors examined the acute effects of cigarette smoking on ABI and the peripheral circulation in 10 older (63 ±10 years) chronic smokers (39 ±37 pack-years) with PAOD (ABI=0.64 ±0.14). The patients were instructed to refrain from smoking and from consuming caffeine-containing beverages for at least 12 hours before the tests. The patients were randomly assigned to 2 days of testing consisting of a nonsmoking and a smoking day. Resting heart rate, blood pressure, ABI, and calf blood flow by plethysmography were obtained on both testing days. The smoking day consisted of smoking two filter cigarettes over a period of 10 minutes before the measurement of ABI and calf blood flow. The ABI on the smoking day (0.55 ±0.11) was lower (p=0.008) than on the nonsmoking day (0.64 ±0.14) owing to a lower (p = 0.020) ankle systolic blood pressure (81 ±28 vs 93 ±28 mmHg). Brachial systolic blood pressures, heart rate, and calf blood flow were not altered by smoking (p>0.05). These results demonstrate that the acute effect of cigarette smoking lowers the ABI in chronic smokers with intermittent claudication, thereby yielding evidence of a transient deleterious effect of cigarette smoking on the peripheral circulation in chronic smokers.

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References

Howard G. , Wagenknecht LE , Burke GL , et al: Cigarette smoking and progression of atherosclerosis. The atherosclerosis risk in communities (ARIC) study. JAMA 279:119-124, 1998.

Multiple Risk Factor Intervention Trial Research Group : Multiple risk factor intervention trial. Risk factor changes and mortality results. JAMA 248: 1565-1577, 1982.

Kannel WB , Schatzkin A. : Risk factor analysis. Prog Cardiovasc Dis 26:309-332, 1983.

Kannel WB , Higgins M. : Smoking and hypertension as predictors of cardiovascular risk in population studies. J Hypertens 89(suppl 5):S3-S8, 1990.

Benowitz N. : Drug therapy: Pharmacological aspects of cigarette smoking and nicotine addiction . N Engl J Med 319:1318-1330, 1988 .

Holbrook JS , Grundy SM , Hennekens CH , et al: Cigarette smoking and cardiovascular diseases: A statement for health professionals by a task force appointed by the steering committee of the American Heart Association. Circulation 70:1114A-1117A, 1984.

Cryer PE , Hymond MW , Santiago JV , et al: Nor-epinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med 295:573-577, 1976.

Rabinowitz BD , Thorp K. , Huber GL , et al: Acute hemodynamic effects of cigarette smoking in man assessed by systolic time intervals and echocardiography. Circulation 60:752-760, 1979.

Koch A. , Hoffmann K. , Steck W. , et al: Acute cardiovascular reactions after cigarette smoking. Atherosclerosis 35:67-75, 1980.

10.

Carter SA : Indirect systolic pressures and pulse waves in arterial occlusive disease of the lower extremities. Circulation 37:624-637, 1968.

11.

Newman AB , Siscovick DS , Manolio TA , et al: Anklearm index as a marker of atherosclerosis in the cardiovascular health study. Circulation 88:837-845, 1993.

12.

McKenna M. , Wolfson S. , Kuller L. : The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 87:119-128, 1982.

13.

Criqui MH , Langer RD , Fronek A. , et al: Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381-386, 1992.

14.

Kornitzer M. , Dramaix M. , Sobolski J. , et al: Ankle/arm pressure index in asymptomatic middle-aged males: An independent predictor of ten-year coronary heart disease mortality. Angiology 46:211-219, 1995.

15.

Gardner AW : The effect of cigarette smoking on exercise capacity in patients with intermittent claudication. Vascular Medicine 1:181-186, 1996.

16.

Gardner AW , Sieminski DJ , Killewich LA : The effect of cigarette smoking on free-living daily physical activity in older claudication patients. Angiology 48:947-955, 1997.

17.

Hiatt WR , Marshall JA , Baxter J. , et al: Diagnostic methods for peripheral arterial disease in the San Luis Valley Diabetes Study. J Clin Epidemiol 43 :597-606, 1990.

18.

Gardner AW , Skinner JS , Cantwell BW , et al: Progressive vs single-stage treadmill tests for evaluation of claudication. Med Sci Sports Exerc 23:402-408, 1991.

19.

May AG , DeWeese JA , Rob CG : Hemodynamics effects of arterial stenosis. Surgery 53: 513-524, 1963.

20.

Trap-Jensen J. , Carlsen JE , Svendsen TL , et al: Cardiovascular and adrenergic effects of cigarette smoking during immediate non-selective and selective beta adrenoreceptor blockade in humans. Eur J Clin Invest 9:181-183, 1979.

21.

Nicod P. , Rehr R. , Winniford MD , et al: Acute systemic and coronary hemodynamic and serologic responses to cigarette smoking in long-term smokers with atherosclerotic coronary artery disease. J Am Coll Cardiol 4:964-971, 1984.

22.

Ricci MA , Fleishman C. , Gerstein N. : The effects of cigarette smoking and smoking cessation aids on transcutaneous oxygen levels. J Vasc Med Biol 4: 256-259, 1993.