Chapter 11 - Atherosclerotic risk factors - Smoking Flashcards
Risk of smoking is highest in these demographics
1) Age 25-44 - 20%
2) American/Indian/Alaska 29%
3) Lower education level
4) lower SES
E-cigarette: what is it and what is the evidence in quitting
Nicotine aerosolized without tobacco
No evidence
Smoking effects
1) Endothelial dysfunction –> low NO, increase ROS, decrease flow-mediated dilatation
2) Prothombotic environment –> increase thromboxane A2, vWF, thrombin, fibrin; decrease prostacyclin, tpa, PAI1
3) inflammatory state: increase leucocyte, CRP, IL6, TNF alpha, IL1beta
Nicotine effects
1) Sympathomimetic –> increase BP
2) insulin resistance
3) altered lipid metabolism
4) endothelial dysfunction
Non-vascular issues with nicotine
1) cancer
2) DM
3) cataracts
4) macular degeneration
5) COPD/asthma
6) rheumatoid arthritis
Framingham study
5209 subjects
Smoking associated with intermittent claudication more so than CAD and CVA
Speedwell study
2348 men
Smoking is the strongest risk factors for intermittent claudication more so than DM and HTN
Women’s Health study
40000 patients Hazzard ratio for getting PAD: 1) 3.16 ex-smoker 2) 11.94 current smk < 15/day 3) 21.08 current smk > 15/day
Smoking cessation hazzard ratio for PAD
< 10 years 0.39
10-19years 0.28
> 20 years 0.16
never smk 0.08
cessation duration matters
Graft failure hazzard ratio to smokers
2.35-3.8
affects both autogenous and prosthetics
3 year amputation risk in smokers
> 15/d
3 year 21%
2% for non smokers
Associated disease with smoking
1) thromboangiitis obliterans (Buerger)
2) aortic aneurysms
Elements of smoking cessation; 5 A’s
1) ask
2) advise
3) assess
4) assist
5) arrange
5 R’s of motivational interview
1) Relevance
2) risks
3) rewards
4) roadblocks
5) repeat
FDA approved 1st line for nicotine replacement
1) gum
2) inhaler
3) lozange
4) nasal spray
5) patch
