Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

  • Choi, Byoung Geol (Department of Medicine, Korea University Graduate School) ;
  • Rha, Seung-Woon (Cardiovascular Center, Korea University Guro Hospital) ;
  • Park, Taeshik (Department of General Internal Medicine, Weiss Memorial Hospital) ;
  • Choi, Se Yeon (Department of Medicine, Korea University Graduate School) ;
  • Byun, Jae Kyeong (Department of Medicine, Korea University Graduate School) ;
  • Shim, Min Suk (Cardiovascular Center, Korea University Guro Hospital) ;
  • Xu, Shaopeng (Cardiovascular Center, Korea University Guro Hospital) ;
  • Li, Hu (Cardiovascular Center, Korea University Guro Hospital) ;
  • Park, Sang-Ho (Department of Cardiology, Soonchunhyang University Cheonan Hospital) ;
  • Park, Ji Young (Cardiovascular Center, Eulji University, Eulji General Hospital) ;
  • Choi, Woong Gil (Cardiovascular Center, Chungju Kunkuk University) ;
  • Cho, Yun-Hyeong (Cardiovascular Center, Seonam University, Myongji Hospital) ;
  • Lee, Sunki (Cardiovascular Center, Korea University Guro Hospital) ;
  • Na, Jin Oh (Cardiovascular Center, Korea University Guro Hospital) ;
  • Choi, Cheol Ung (Cardiovascular Center, Korea University Guro Hospital) ;
  • Lim, Hong Euy (Cardiovascular Center, Korea University Guro Hospital) ;
  • Kim, Jin Won (Cardiovascular Center, Korea University Guro Hospital) ;
  • Kim, Eung Ju (Cardiovascular Center, Korea University Guro Hospital) ;
  • Park, Chang Gyu (Cardiovascular Center, Korea University Guro Hospital) ;
  • Seo, Hong Seog (Cardiovascular Center, Korea University Guro Hospital) ;
  • Oh, Dong Joo (Cardiovascular Center, Korea University Guro Hospital)
  • Received : 2015.10.01
  • Accepted : 2016.02.16
  • Published : 2016.09.30
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Abstract

Background and Objectives: Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods: A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results: There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion: Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.

Keywords

Acknowledgement

Grant : BK21플러스

Supported by : 고려대학교

References

  1. Kugiyama K, Yasue H, Okumura K, et al. Nitric oxide activity is deficient in spasm arteries of patients with coronary spastic angina. Circulation 1996;94:266-71. https://doi.org/10.1161/01.CIR.94.3.266
  2. Kugiyama K, Ohgushi M, Motoyama T, et al. Nitric oxide-mediated flow-dependent dilation is impaired in coronary arteries in patients with coronary spastic angina. J Am Coll Cardiol 1997;30:920-6. https://doi.org/10.1016/S0735-1097(97)00236-2
  3. Kugiyama K, Murohara T, Yasue H, et al. Increased constrictor response to acetylcholine of the isolated coronary arteries from patients with variant angina. Int J Cardiol 1995;52:223-33. https://doi.org/10.1016/0167-5273(95)02478-6
  4. Beltrame JF, Sasayama S, Maseri A. Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian patients. J Am Coll Cardiol 1999;33:1442-52. https://doi.org/10.1016/S0735-1097(99)00073-X
  5. Erhardt L. Cigarette smoking: an undertreated risk factor for cardiovascular disease. Atherosclerosis 2009;205:23-32. https://doi.org/10.1016/j.atherosclerosis.2009.01.007
  6. Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993;87:76-9. https://doi.org/10.1161/01.CIR.87.1.76
  7. Wolf PA, D'Agostino RB, Kannel WB, Bonita R, Belanger AJ. Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA 1988;259:1025-9. https://doi.org/10.1001/jama.1988.03720070025028
  8. Bornemisza P, Major G, Suciu I, Major I. Cigarette smoking as a risk factor for atherosclerosis. Study of the biologic changes consecutive to smoking in normals, in patients with coronary heart disease and in diabetics. Med Interne 1981;19:251-8.
  9. Cheon BW, Rha SW, Wani SP, et al. Impact of smoking and smokingrelated parameters on acetylcholine-induced coronary artery spasm. Korean Circ J 2006;36:661-5. https://doi.org/10.4070/kcj.2006.36.9.661
  10. Brunner H, Cockcroft JR, Deanfield J, et al. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens 2005;23:233-46. https://doi.org/10.1097/00004872-200502000-00001
  11. de Maat MP, Pietersma A, Kofflard M, Sluiter W, Kluft C. Association of plasma fibrinogen levels with coronary artery disease, smoking and inflammatory markers. Atherosclerosis 1996;121:185-91. https://doi.org/10.1016/0021-9150(95)05716-1
  12. Park JY, Rha SW, Li YJ, et al. The impact of high sensitivity C-reactive protein level on coronary artery spasm as assessed by intracoronary acetylcholine provocation test. Yonsei Med J 2013;54:1299-304. https://doi.org/10.3349/ymj.2013.54.6.1299
  13. Takaoka K, Yoshimura M, Ogawa H, et al. Comparison of the risk factors for coronary artery spasm with those for organic stenosis in a Japanese population: role of cigarette smoking. Int J Cardiol 2000;72:121-6. https://doi.org/10.1016/S0167-5273(99)00172-2
  14. Figueras J, Domingo E, Ferreira I, Lidon RM, Garcia-Dorado D. Persistent angina pectoris, cardiac mortality and myocardial infarction during a 12 year follow-up in 273 variant angina patients without significant fixed coronary stenosis. Am J Cardiol 2012;110:1249-55. https://doi.org/10.1016/j.amjcard.2012.06.026
  15. Choi BG, Park SH, Rha SW, et al. Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity scorematched analysis. Int J Cardiol 2015;184:533-9. https://doi.org/10.1016/j.ijcard.2015.02.021
  16. Bakhru A, Erlinger TP. Smoking cessation and cardiovascular disease risk factors: results from the Third National Health and Nutrition Examination Survey. PLoS Med 2005;2:e160. https://doi.org/10.1371/journal.pmed.0020160
  17. Haustein KO, Krause J, Haustein H, Rasmussen T, Cort N. Changes in hemorheological and biochemical parameters following short-term and long-term smoking cessation induced by nicotine replacement therapy (NRT). Int J Clin Pharmacol Ther 2004;42:83-92. https://doi.org/10.5414/CPP42083

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