The Effect of Smoking on the Baroregulatory System; Heart Rate Turbulence

Öz

Introduction: Smoking has been known to cause various adverse cardiovascular reactions. Our study was conducted to demonstrate the chronic effects of smoking on baroregulatory function by using heart rate turbulence (HRT) parameters among asymptomatic smokers. Materials and Methods: Sixty four smokers with histories of incessant smoking for at least one year (group 1) and 30 non-smokers (group 2) were enrolled in this study. Addiction of smoking was graded according to the modified Fagerström test for nicotine dependence (m-FNDT). Each smoker was conferred a nicotine dependence index (NDI) according to the m-FNDT. The values of HRT (TO: Turbulence onset, TS: Turbulence slope) were compared between two groups along with basic clinical, echocardiographic and Holter parameters. And the relationship between HRT and m-FDT was analyzed. Results: There was no significant difference the basic clinical and echocardiographic features (p> 0.05). The mean value of TO was higher significantly (p< 0.05) in group 1 than group 2, the mean values of TS was not different significantly between the two groups. The value of NDI was positively correlated with the value of TO (p< 0.05). Conclusion: Smoking impaired baroregulatory function especially in TO, even in asymptomatic smokers.

Anahtar Kelimeler

• Smoking; heart rate; nicotine; tobacco use disorder.

Sigara Alışkanlığının Baroregülatuvar Sisteme Olan Etkisi; Kalp Hızı Türbülansı

Öz

Giriş: Sigaranın kardiyovasküler sisteme olan zararlı etkileri bilinmektedir. Çalışmamızın amacı sigara içiminin baroregülatuvar mekanizmaya olan etkilerini, kalp hızı türbülansını kullanarak normal kişilerle karşılaştırmaktır. Materyal ve Metod: En az bir yıldır sigara içme öyküsü olan asemptomatik 64 kişi grup 1 olarak kabul edildi. Aynı klinik özelliklere sahip asemptomatik sigara alışkanlığı olmayan 30 kişi grup 2 olarak düzenlendi. Çalışmaya alınan grup 1'deki sigara içicilerinin nikotin bağımlılık indeksi (NBİ) modifiye-Fagerström Nikotin bağımlılık testi (m-FNBT) kullanılarak hesaplandı. Tüm gruplardaki hastalara 24 saatlik elektrokardiyografi Holter takılarak, tamamının HRT (TO, total onset ve TS, total slope) ile bazal ekokardiyografik parametreleri hesaplandı. Bulgular: Gruplar arasında taşıdıkları demografik, klinik ve ekokardiyografik özellikler açısından istatistiksel olarak anlamlı bir fark saptanmadı (p> 0.05). Grup 1'de ortalama TO değeri anlamlı olarak yüksek iken (p< 0.05), ortalama TS değerleri arasında iki grup arasında istatistiksel olarak anlamlı bir fark saptanmadı (p> 0.05). Grup 1'de hesaplanan NBİ değeri ile ortalama TO arasında pozitif korelasyon saptandı (p< 0.05). Sonuç: Kronik sigara içicisi olanlarda, aynı özelliklere sahip içmeyen gruba oranla baroregülatuvar mekanizmada (özellikle TO) bozulma olduğu saptandı

Anahtar Kelimeler

• Sigara içme; kalp hızı; nikotin; tütün kullanımı.

Kaynakça

1. World Health Organization. The World Health Report, 2002. Reducing Risks, Promoting Healthy Life. Geneva (Switzerland): World Health Organization, 2002.
2. Gidding SS, Xie X, Liu K, Manolio T, Flack JM, Gardin JM. Cardiac function in smokers and non-smokers: the CARDIA study. J Am Coll Cardiol 1995;26:211-6.
3. Hill P, Wynder EL. Smoking and cardiovascular disease: effect of nicotine on the serum epinephrine and corticoids. Am Heart J 1974;87:491-6.
4. Narkiewicz K, van de Borne PJ, Hausberg M, Cooley RL, Winniford MD, Davison DE, et al. Cigarette smoking increases sympathetic outflow in humans. Circulation 1998;98:528-34.
5. Goldenberg I, Moss AJ, McNitt S, Zareba W, Daubert JP, Hall WJ, et al. Cigarette smoking and the risk of supraventricular and ventricular tachyarrhythmias in high-risk cardiac patients with implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 2006;17:931-6.
6. Zhu B, Parmley WW. Hemodynamic and vascular effects of active and passive smoking. Am Heart J 1995;130:1270-5.
7. Hallstrom AP, Cobb LA, Ray R. Smoking as a risk factor for recurrence of sudden cardiac arrest. N Engl J Med 1986;314:271-5 .
8. Mrowka R, Persson PB, Theres H, Patzak A. Blunted arterial baroreflex causes “pathological” heart rate turbulence. Am J Physiol Regul Integr Comp Physiol 2000;279:R1171-5.

9. Yap YG, Camm AJ, Schmidt G, Malik M. Heart rate turbulence is influenced by heart rate, age, LVEF, NYHA class, diabetes, drugs and frequency of ventricular ectopics in patients after acute myocardial infarction-EMIAT substudy (abstr). J Am Coll Cardiol 2001;37(Suppl A):133A.
10. Barthel P, Schneider R, Bauer A, Ulm K, Schmitt C, Schömig A, et al. Risk stratification after acute myocardial infarction by heart rate turbulence. Circulation 2003;108:1221-6.
11. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nictoine dependence: a revision of the Fagerstrom tolerance questionnaire. British Journal of Addictions 1991;86:1119-27.
12. Schmidt G, Malik M, Barthel P, Schneider R, Ulm K, Rolnitzky L, et al. Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet 1999;9162:1390-6.
13. Exner DW, Kavanagh KM, Slawnych MP, Mitchell LB, Aggarwal SG, Aggarwal SG, et al. On behalf of REFINE Investigators. Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol 2007;50:2275-84.
14. Cryer PE, Haymond MW, Santiago JV, Shah SD. Norepinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med 1976;296:573-7.
15. Niedermaier ON, Smith ML, Beightol LA, Zukowska-Grojec Z, Goldstein DS, Eckberg DL. Influence of cigarette smoking on human autonomic function. Circulation 1993;88:562-71.
16. Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: Implications for nicotine replacement therapy. J Am Coll Cardiol 1997;29:1422-31.
17. Cryer PE, Haymond MW, Santiago JV, Shah SD. Norepinephrine and epinephrine release and adrenergic mediation of smokingassociated hemodynamic and metabolic events. N Engl J Med 1976;295:573-7.
18. Waeber B, Schaller MD, Nussberger J, Bussien JP, Hofbauer KG, Brunner HR. Skin blood flow reduction induced by cigarette smoking: role of vasopressin. Am J Physiol 1984;247:895-901.
19. Celermajer DS, Sorensen KE, Georgeakopoulos D, Bull C, Thomas O, Robinson J, et al. Cigarette smoking is associated with dose-related and potentially reversible impairment of endotheliumdependent dilation in healthy young adults. Circulation 1993;88: 2149-55.
20. Benowitz N. Drug therapy: pharmacologic aspects of cigarette smoking and nicotine addiction. N Engl J Med 1988;319:1318-30. 21. Escobedo LG, Zack MM. Comparison of sudden death and nonsudden coronary death in the United States. Circulation 1996;93:20336.
21. Stewart PM, Catterall JR. Chronic nicotine ingestion and atrial fibrillation. Br Heart J 1985;54:222-3.
22. Eryonucu B, Bilge M, Güler N, Uzun K, Gencer M. Effects of cigarette smoking on the circadian rhythm of heart rate variability. Acta Cardiol 2000;55:301-5.
23. Kupari M, Virolainen J, Koskinen P, Tikkanen MJ. Short-term heart rate variability and factors modifying the risk of coronary artery disease in a population sample. Am J Cardiol 1993;72:897-903.
24. Barutcu I, Esen AM, Kaya D, Turkmen M, Karakaya O, Melek M, et al. Cigarette smoking and heart rate variability: dynamic influence of parasympathetic and sympathetic maneuvers. Ann Noninvasive Electrocardiol 2005;10:324-9.
25. Levin FR, Levin HR, Nagoshi C. Autonomic functioning and cigarette smoking: heart rate spectral analysis. Biol Physchiatry 1992;31:639-43.
26. Watanabe MA. Heart rate turbulence: a review. Indian Pacing and Electrophysiology Journal (ISSN 0972-6292) 2003;3:10-22. 28. Yap YG, Camm AJ, Schmidt G, Malik M. Heart rate turbulence is influenced by sympathovagal balance in patients after myocardial infarction-EMIAT substudy. Eur Heart J 2000;21(Suppl.):474.
27. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:e25-146.
28. Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Blunted heart rate dip during sleep and all-cause mortality. Arc Intern Med 2007;167:2116-21.
29. Kannel WB, Kannel C, Paffenbarger RS Jr, Cupples LA. Heart rate and cardiovascular mortality: the Framingham Study. Am Heart J 1987;113:1489-94.
30. Benetos A, Rudnichi A, Thomas F, Safar M, Guize L. Influence of heart rate on mortality in a French population. Role of age, gender, and blood pressure. Hypertension 1999;33:44-52.
31. Reunanen A, Karjalainen J, Ristola P, Heliovaara M, Knekt P, Aromaa A. Heart rate and mortality. J Intern Med 2000;247:231-9. 34. Greenland P, Daviglius ML, Dyer AR, Liu K, Huang CF, Goldberger JJ, et al. Resting heart rate is a risk factor for cardiovascular and non-cardiovascular mortality. Am J Epidemiol 1999;149:853-62.
32. Kristal-Boneh E, Silber H, Harari G, Froom P. The association of resting heart rate with cardiovascular, cancer and all-cause mortality. Eight year follow-up of 3527 male Israeli employees (the CORDIS Study). Eur Heart J 2000;21:116-24.