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Related Experiment Videos

The smoker's--a hemodynamic reality?

Nuno Bettencourt1, Pedro Mateus, Carla Dias

  • 1Centro Hospitalar de Vila Nova de Gaia-Serviço de Cardiologia, Vila Nova de Gaia, Portugal. nunobett@netcabo.pt

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|July 1, 2004
PubMed
Summary

Smokers experiencing acute coronary syndrome (ACS) are younger and have different risk factors than non-smokers. After accounting for these differences, the "smoker's paradox" of better outcomes is not confirmed.

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Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Smoking is a significant cardiovascular risk factor.
  • Smokers with acute coronary syndrome (ACS) paradoxically appear to have better prognoses.
  • The thrombotic effects of smoking have been hypothesized to explain this "smoker's paradox".

Purpose of the Study:

  • To compare clinical and hemodynamic characteristics of patients hospitalized for ACS based on smoking status.
  • Investigate potential differences in disease presentation, severity, and outcomes between smokers and non-smokers.

Main Methods:

  • Retrospective analysis of 903 patients hospitalized for ACS between 2001 and 2002.
  • Patients divided into current smokers (F) and never-smokers (NF) groups.
  • Comparison of demographics, clinical presentation (ECG, troponin), coronary anatomy, hospital stay, and mortality.

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Main Results:

  • Smokers (F) were significantly younger (mean age 54) than non-smokers (NF) (mean age 69).
  • Non-smokers had higher prevalence of hypertension and diabetes, while smokers had more dyslipidemia.
  • Smokers showed more ST-elevation ACS and higher peak troponin levels; however, non-smokers had longer hospital stays and higher mortality (6.6% vs 2.6%).
  • Multivariate analysis adjusting for age and sex eliminated significant differences in outcomes between groups.

Conclusions:

  • The younger age and distinct epidemiological profile of smoking patients contribute to observed differences in ACS presentation and outcomes.
  • The "smoker's paradox" of a better prognosis is not supported by multivariate analysis in this study population.
  • The hypothesis of a hemodynamic cause for the "smoker's paradox" could not be confirmed.