Title : Smoking status and early vascular aging: How to reduce cardiovascular risk at the current stage of knowledge?
Abstract:
Background: Smoking status (SS) is associated with structural and functional vascular changes which may lead to increased arterial stiffness and, as a consequence, the formation of early vascular aging. The purpose of this study was to investigate the relationship between the modifiable risk factors and early vascular aging (EVA-syndrome).
Material and methods: The material of the study was the data of a survey of 783 men aged 20 to 92 years (mean age 48.2±10.32 years) undergoing medical examination in the group of the St-Petersburg State University clinics. To assess the vascular age, the AngioScan-01 photoplethysmography method was used. The following indicators were evaluated: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI) and pulse wave types (PV-type). To determine the vascular age (VA), a correlation field of the dependence of the actual (passport) age on the age index (AGI) was built. The age of the vascular system was calculated from the value of the age index.
Results: The greatest correlation with passport age was revealed for the “age index” indicator (r=0.54, p = 0,000). EVA-syndrome criteria were considered as values of the AGI, beyond the 90th percentile (n = 65), and the criteria for “Young Vascular Age” (n=87) were AGI values below 10 percentile. Comparison of these two alternative subgroups (in men aged from 40 to 59) in terms of arterial stiffness showed significant differences in terms of SI, Alp75, PV-type. The frequency of detection of multiple risk factors according to the results of questionnaires and laboratory diagnostics was also significantly higher. The leading vascular risk factors for EVA syndrome were arterial hypertension (OR=4.4; p<0.05), hyperglycemia (OR=3.2; p<0.05), hypertriglyceridemia (OR) = 2.9; p < 0.05) and smoking status (OR = 2.23, p < 0.05?. Long-term (more than 20 years) smoking history was associated with 11.6 potential years of life lost compared with never smokers, former smokers, or users of reduced-risk products.
Conclusion: Smoking status should be considered as the most aggressive of all behavioral risk factors. Its contribution to early vascular aging was significantly greater than risk factors such as abdominal obesity, physical inactivity, stressful work patterns, unrestricted diet and alcohol abuse .The data obtained support the importance of developing an algorithm for the actions of a therapist and a cardiologist using the harm reduction concept in the fight against smoking as a key behavioral risk factor for the development of ASCVD and a reduction in life expectancy, as well as recommendations for the use of less harmful alternatives to slow or reverse the progression of arterial ageing. The harm reduction concept of switching from cigarette smoking to alternative nicotine delivery systems may have positive elements in improving CVD prognosis, so adult smokers who are not currently motivated to quit should have reliable information about products with scientifically proven health risk reduction.
