B P4 C28 Cardiovascular Disease Risk of Nicotine and Tobacco Products

Question 1

The number one cause of preventable death worldwide.

In 2019, tobacco product use was the leading risk factor for mortality in men, and the seventh leading risk factor for women

Answer 1

Tobacco smoking

Question 2

The lung and cardiovascular systems appear to be most vulnerable, and ______ are the leading cause of death among smokers

Answer 2

Cardiovascular diseases (CVDs; including stroke)

Question 3

Smoking cigarettes affects multiple forms of CVD. The risk of CVD due to smoking is in general lower than the risk of lung cancer.

Highest relative risk for CVD and Pulmonary disease among current smokers

Answer 3

CVD - AAA (4.87 RR), PAD (3.94 RR)

Pulmonary - Lung Ca (8.93 RR), COPD (4.01 RR)

Question 4

Smoking cigarettes affects multiple forms of CVD. The risk of CVD due to smoking is in general lower than the risk of lung cancer.

Highest relative risk for CVD and Pulmonary disease among current smokers

Answer 4

CVD - AAA (4.87 RR), PAD (3.94 RR)

Pulmonary - Lung Ca (8.93 RR), COPD (4.01 RR)

Question 5

Extensive evidence suggests that one of the key targets of smoking is the ______________.

Answer 5

Endothelium

In humans, smoking acutely causes
Endothelial cell damage
Diminishes endothelium-mediated relaxation
Long-term smoking is associated with impaired endothelium-dependent relaxation in conduit and coronary arteries

Question 6

These changes in the endothelium have been linked to a decrease in the bioavailability of _________ in smokers.

Answer 6

Nitric oxide

Question 7

Smoking-induced vascular d function not only affects blood pressure regulation, but by altering the integrity of the vessel wall, it promotes the formation of _______

Answer 7

Atherosclerotic lesions

It has been found that cigarette smoking is an independent predictor of new coronary lesion formation and that smoking is associated with a consistent increase in intimal-medial thickness of the carotid artery.

Question 8

Smoking could promote atherosclerosis also by affecting lipid metabolism that include

Answer 8

Higher levels of serum cholesterol, triglycerides, and low-density lipoprotein (LDL)-cholesterol
Lower levels of high-density lipoprotein (HDL) cholesterol

Question 9

Cigarette smoking can also increase the risk of CVD by affecting thrombosis and coagulation that include

Answer 9

Higher circulating levels of fibrinogen
Increased platelet aggregation
Affects tissue factor (TF) and TF pathway inhibitor-1
Increased blood viscosity, red blood cell counts, and hematocrit

Question 10

In _______, smoking has been associated with sudden cardiac death due to plaque erosion leading to the formation of a large occlusive thrombus

Answer 10

Women

Question 11

Cigarette smoke, as well as smoke from combustible and HTPs, contains ______, which may be responsible for the cardiovascular risk of smoking.

Answer 11

Fine particulate matter (PM)

Question 12

Major portion of the toxicity of cigarettes could be attributed to VOCs such as ________

Answer 12

Acrolein

Question 13

Jicotine is a potent _____ drug, which upon binding to very specific cholinergic receptors in nervous tissue elicits a wide range of metabolic and physiologic responses that could significantly affect vascular function, cardiac contractility, and lipid metabolism

Answer 13

Sympathomimetic

Question 14

________ are electronic nicotine delivery systems (ENDS) that aerosolize a solution of nicotine in propylene glycol and vegetable glycerin (PG:VG). 3

Answer 14

E-cigarettes

Question 15

Acute use of e-cigarettes by smoki healthy subjects has been shown to _______, indicating obstruction of the conducting airways

Answer 15

Increase flow resistance

Question 16

Those who use e rettes regularly show inflammatory changes in their lungs, and their airways appear ______ indicating ongoing subclinical injury.

Answer 16

“friable and erythematous,”

Question 17

In healthy adults, a single bout of e-cigarette use increases _______ as well as aortic stiffness

Answer 17

Increases systolic and diastolic blood pressure

Question 18

As in the case of cigarettes, these effects of e arettes are accompanied by a marked shift in cardiac sympathovagal balance toward ______ predominance.

Answer 18

Sympathetic

Question 19

The use of e-cigarettes has also been shown to impair vascular function and to attenuate flow-mediated dilation, peak velocity, and the hyperemic index.

It also leads to an increase in arterial stiffness, but a reduction in _____

Answer 19

Acetylcholine-mediated vasodilation

Question 20

A particularly striking example of the acute injury caused by e-cigarette use is provided by the cases of _____

Answer 20

Electronic cigarette or vaping-induced lung injury (EVALI)

Lung biopsies of EVALI patients showed signs of subacute lung injury, multifocal ground glass-opacity frequently with organizing consolidation, interlobular septal thickening, diffuse alveolar damage, and organizing pneumonia.

These are all changes indicative of extensive lung damage, fluid accumulation, airway collapse, and fibrosis that often resulted in death.

Question 21

_________ rather than decreasing smoking intensity, is required to fully redeem the health benefits of withdrawing from tobacco use.

Answer 21

Full abstinence