Smoking is an important cardiovascular risk factor and thereby strongly related to cerebral ischemia and myocardial infarction. Here we evaluated subclinical effects of smoking behaviors on arterial stiffness and left ventricular diastolic function in middle-aged individuals without known cardiovascular disease. Within a gender and age stratified random sample diastolic function was assessed by standardized echocardiography at baseline and again after ten years. Furthermore pulse wave analysis was performed at the follow-up investigation. Within a healthy subgroup aged 25 to 44 years at baseline (n=400) associations between smoking behaviors and LV diastolic function as well as arterial stiffness were assessed by comparison of non-smokers (nonS, consisted of never smokers and individuals who stopped active smoking at least 10 years before follow-up investigation), ex-smokers (exS, individuals who stopped smoking within 10 years of follow-up), and current smokers (curS). Adjusted mean values were calculated by linear regression models. As compared to non-smokers, current smokers as well as ex-smokers presented with worse diastolic function at follow-up. Specifically, they displayed lower e/a-ratios (curS 1.23 95%-CI [1.19, 1.28]; exS 1.23 [1.15, 1.32]) as compared to nonS (1.33 [1.29, 1.36], p-values 0.001 and 0.041, respectively). Additionally, declines of e/a-ratios associated with ageing by 10 years were also significantly different (curS −0.35 [−0.39, −0.31]; exS −0.39 [−0.46, −0.31]; vs. nonS −0.27 [−0.30, −0.24]; each p=0.006). Furthermore, curS presented with increased arterial stiffness as displayed by higher augmentation index (curS 20.1 [18.5, 21.6]; exS 16.7 [13.9, 19.6]; vs. nonS 16.7 [15.5, 17.9], p<0.001 and p=0.995) and shorter time to reflection (curS 141ms [139, 143]; exS 147ms [143, 151]; vs. nonS 145ms [143, 146], p=0.005 and p=0.265). In middle-aged healthy individuals smoking is strongly related to subclinical changes in arterial stiffness and diastolic function. But even after termination of active smoking these changes partly persist. Consequently, interventional programs addressing younger adults are essential to prevent premature cardiovascular ageing.
Abnormal left ventricular diastolic function at late follow-up after repair of total anomalous pulmonary venous drainage: The impact of altered ventricular loading in utero
